bluuebunny/crossref_metadata_2025_split huggingface dataset:
424 Early Outcomes of the Insides Chyme Reinfuser (ICR) in the Management of High-Output Stoma
Authors: Mohamed R , Htet W , Wilson J , Magee C 
Published: August 2023

Abstract

Aim
High-output stomas present a significant surgical, nursing, nutritional and patient challenge. Patients are at risk of complications ranging from disrupted GI and renal physiology to severe complications from vascular access.
The ICR device allows chyme to be reinfused and may be a promising way to establish early enteral feeding, shorten hospital stays, and reduce complications such as significant GI losses and prolonged parenteral feeding.
We aimed to investigate the early outcome of ICR in our initial cohort of patients.

Method
Prospective analysis of all patients using ICR from 2020-2022. Outcomes included: primary pathology, hospital stay, duration of Parenteral nutrition, albumin level, commencement and tolerance of Chyme reinfusion, and mortality.

Results
Eight patients used ICR. Five became independent in using the device. Four were successfully reversed with one waiting reversal. In all patients, a significant reduction in using parenteral nutrition was noted as five patients were nutritionally autonomous whilst using ICR.
Although an imperfect marker, albumin levels responded to ICR use (an average improvement from 31g/L to 38g/L).
One patient died due to complications from the primary pathology.

Conclusions
The ICR device is safe and effective. It can be used by nursing patients and most patients. Our data suggest a possible reduction in TPN use which will have financial and clinical benefits. The ICR device should be considered in selected patients. There remains considerable mortality in patients with significant co-morbidity who are left with a high-output stoma.
467 Fluid Balance Documentation and Fluid Prescribing in Surgical Patients at a District General Hospital: Are Posters Too Passive for an Effect?
Authors: Mostafa O , Rafiq O , Waraich N 
Published: August 2023

Abstract

Aim
t is estimated that 1-in-5 patients receiving intravenous (IV) fluid therapy suffer from complications following inappropriate fluid prescribing. In March 2022, a spot audit evaluating fluid management in 20 surgical patients highlighted inaccuracies in fluid balance documentation, with up to 70% of sampled patients in an excess fluid balance.
As interventions, educational posters and teaching on IV fluids were delivered to doctors and nurses. A second audit cycle was sought to re-assess the impact of the interventions.

Method
A 30-item proforma was used to audit 100 general surgical patients between May-June 2022. Parameters collected included reasons for IV fluids and renal function. To assess doctors’ satisfaction with the intervention, an online survey was distributed among doctors working in General Surgery. All data were analysed using statistical software (SPSS).

Results
Half of the sampled patients were on IV fluids. Only 50% had an indication documented, and 56% had IV fluids in their management plan. 37% were in fluid excess. Accurate urine and stool measurements were recorded in 68% and 75% of patients, respectively. Drains and stomas were higher (relative to the first cycle). All doctors felt the posters were beneficial; only 36% of doctors felt comfortable with fluid prescribing before the posters, which increased to 93% after the posters were distributed.

Conclusions
Fluid management remains a cornerstone of surgical care. Fluid status should be incorporated into the daily patient assessment. Visual tools, such as posters, need objective assessment over longer durations to evaluate their benefit for healthcare professionals and patients.
531 Virtual Fracture Clinic Management During the COVID-19 Pandemic at Glasgow Royal Infirmary: The MAVCOV Study
Authors: Loh C , Baig S , Russell A , Pravinkuma R , Cemm N , Drury C 
Published: August 2023

Abstract

Aim
To evaluate the efficacy of the Virtual Fracture Clinic (VFC) in terms of patient satisfaction and clinical outcome, pre and during COVID at Glasgow Royal Infirmary (GRI). The impact of the pandemic on the quality of patient management was assessed by comparing two sets of patients who (1) presented to the clinic when British Orthopaedic Association Standards for Trauma and Orthopaedics (BOAST) COVID-19 guidelines were first introduced (Pre-Lockdown Cohort) and (2) presented after practitioners were familiar with these guidelines (Lockdown Cohort).

Method
This was a retrospective review of VFC patients. Data extracted included demographic information, management plans and three-month follow-up outcomes. Patients discharged without further follow-up underwent a telephone questionnaire to assess patient satisfaction.

Results
286 patients were included in this study. 96.7% of patients in the pre-lockdown cohort presented to the VFC within 3 days of presentation as opposed to 93.3% of the lockdown cohort. 54.1% of the pre-lockdown cohort were referred to face-face/specialty clinics as opposed to 44.8% of the lockdown cohort. 6.9% of a subset of the lockdown cohort had an unplanned re-attendance to hospital for associated pain as opposed to 1.12% of a subset of the pre-lockdown cohort. 72% of the pre-lockdown cohort reported they were ‘very satisfied’ as opposed to 40% of the lockdown cohort.

Conclusions
The data reflects that there was a net shift from face-face consultations to discharge with nurse call between the pre-lockdown cohort and lockdown cohort however, this came with a substantial drop in patient satisfaction and an increased re-attendance rate.
587 An Audit to Establish the Need for Ear, Nose and Throat Antibiotic Guidelines at a Teaching Hospital in the UK
Authors: Le Blevec L , Shahsavari S , Walker D 
Published: August 2023

Abstract

Aim
Correct antimicrobial prescribing is paramount in providing and improving the safety and quality of patient care. The aim of the audit was to assess how confident doctors who treat patients with ear, nose and throat (ENT) conditions at a teaching hospital were at prescribing the correct antimicrobial therapy, as well as how confident they were in finding the relevant guideline.

Method
A survey was sent via email to emergency department, ENT and surgical clinicians in this hospital ranging from foundation year one doctors to consultants. They were asked a series of questions using a five-point likert scale.

Results
Thirty-one responses were collected, mostly from emergency department clinicians (64.5%) and ENT (29%), of which 41.9% were consultants, 19.4% non-training grade SHOs and 12.9% foundation year one doctors. Nearly half (48.4%) were only ‘somewhat’ to ‘not at all confident’ in prescribing the correct antibiotics for ENT patients. 58.1% were ‘somewhat’ to ‘not at all confident’ in finding antibiotic guidelines for ENT conditions in this specific hospital. 96.4% suggested an ENT section on ‘MicroGuide’ (a mobile platform to distribute antimicrobial guidelines) would be useful plus or minus a poster.

Conclusions
This study showed there was a significant need for secondary care ENT guidelines at this local hospital. Due to limitations of physical guidelines such as posters becoming outdated, we planned to collaborate with the microbiology team to create online ENT antibiotic guidelines on MicroGuide.
612 Consultant Review in the Emergency General Surgical Take: A Single-Centre Audit for Compliance to Royal College of Surgeon’s Guidelines
Authors: Salih M , Dyer C , Salih S , McRobb J , Sheth H 
Published: August 2023

Abstract

Aim
To assess if patients are reviewed within the timeframe suggested by the Royal College of Surgeons England (RCSE) and the association of guideline adherence with clinical outcomes in the emergency surgical take.

Method
We conducted a single-centre closed loop audit to assess the time taken for consultant review of the acute surgical patient. Clinical notes and electronic records were used to collect data on the acuity of the presenting complaint, time of review and plan by the consultant surgeon. Data was collected over an 8-week period before and after implementing changes in the form of educational sessions and email reminders regarding documentation. Post-implementation showed an improvement in record taking and, subsequently, increased compliance to RCSE guidelines.

Results
In the first and second cycle of this audit, 211 and 230 patients were seen, respectively. Before our intervention, of the 211 patients admitted to general surgery, 70% were reviewed within the recommended time, 10% had missing documentation and the remaining 20% were seen 1-2 hours outside the recommended window of time. Following intervention, 80% of the total surgical patients were reviewed within the recommended time and 5% had missing documentation. No worse outcomes were noted between any group of patients, outside the timeframe or otherwise.

Conclusions
Most patients reviewed on the general surgical take were seen within the recommended time. Below-standard documentation appeared to be the biggest cause of not meeting guidelines. Consistency regarding types of documentation, as well as teaching to highlight the standard of documentation required, may help rectify this.
627 The Use of Gastrograffin in Adhesive Small Bowel Obstruction (ASBO)
Authors: Tabassum T , Rehman S , Ibrahim M 
Published: August 2023

Abstract

Background
SBO constitutes 12–16% of emergency surgical admissions and 20% of emergency surgical procedures. As per Bologna guidelines, partial adhesive small bowel obstruction (ASBO) can be managed safely with non-operative management with WSCM and tube decompression. The radiologic appearance of WSCM in colon within 24hrs from administration predicts resolution. According to NASBO recommendations, WSCM should be embedded into prognostic and therapeutic management of ASBO. We investigated the use of gastrografin amongst patients who had ASBO and audited the practice in our hospital.

Method
We collected and analysed retrospective data of patients who received gastrografin from February 2022 to September 2022. CTscan-identified ASBO cases were included. We excluded cases of gastrografin use for other bowel obstruction aetiologies e.g. hernias, extrinsic compression, post-operative ileus, or when CT scan did not explicitly report adhesive aetiology.

Results
In 54 patients who received gastrografin, 27 were identified to be for ASBO by CT scan (50%). Of these, 24 (89%) received gastrografin within 24 hours of NG tube insertion. 21 (78%) successfully resolved with gastrografin administration alone with 6 (22%) going on to have surgery. The mean duration of conservative management in gastrografin-resolved ASBO was 2 days.

Conclusions
We demonstrate that non-operative management should initially be attempted in patients with uncomplicated partial ASBO, with gastrografin use showing therapeutic benefit. Lack of resolution after 24hrs of administration should be considered for surgical adhesiolysis. CT reporting of specific SBO aetiology should be encouraged to better guide whether gastrografin is indicated.
634 Analgesia Use in Acute Renal Colic Patients- Complete Audit Cycle
Authors: Husain S , Otite U 
Published: August 2023

Abstract

Aim
Prevalence of renal colic is up to 20% worldwide, with recurrence rates approaching 50% within 10 years- making it a common acute presentation. NICE guidance (NG118) states NSAIDs are first-line analgesia for renal colic, followed by intravenous paracetamol and opiates. Our aim was to assess compliance with NG118 within one acute NHS teaching Trust.

Method
All patients with renal colic as the primary differential diagnosis during March and April 2022 (1st cycle) and September and October 2022 (2nd cycle) were included. Data was extracted retrospectively from electronic patient records into a pre-designed proforma. Findings from the 1st cycle were presented within local departmental meetings. Posters were also installed reminding clinicians of the analgesic pathway within the relevant clinical areas. Subsequently, a re-audit was performed.

Results
90 patients were included (60- 1st cycle, 30- 2nd cycle). There was a significant improvement in compliance between the 1st and 2nd audit cycles (60% versus 83%, p = 0.0193). However in cases of non-compliance, documentation was poor (&gt;70% did not state a reason) during both cycles. Imaging confirmed renal colic in 82% of patients in the 1st cycle and 93% of patients in the 2nd cycle. PR Diclofenac was the most common NSAID prescribed.

Conclusions
Low-cost, easily reproducible interventions resulted in significant prescribing practice changes. Findings from the latest national renal colic audit (2012-13) showed analgesia compliance in only 69% of cases nationally- similar to our 1st audit cycle results. Disseminating our findings to other hospitals regionally and nationally will hopefully result in better outcomes for renal colic patients.
683 Closed Loop Regional Audits on Quality Predictive Indicators for Renal Cell Carcinoma Management in Northern Ireland
Authors: Simon N , Curry D , Devine A 
Published: August 2023

Abstract

Aim
To conduct a full cycle Regional Audit in Northern Ireland to assess the ten Quality Predictive Indicators (QPI) in the management of Renal Cell Carcinoma (RCC) as per National Cancer Quality Steering Group (NCQSG) of NHS Scotland. Each cycle lasted for 6 months.

Method
QPIs were assessed in four major domains such as radiological, histological, surgical and pre-treatment performance indicators in the management of RCC. Using the Northern Ireland Electronic Care record, data were collected, recorded in MS Excel and analysed and arrived at conclusions. The results were compared with NHS Scotland RCC audit reports published in August 2019 and October 2022.

Results
In audit cycle 1, NCGSQ targets of quality prediction was achieved in 3 QPIs (Nephron Sparing Surgery, Trifecta rate and 30/90 mortality rate) among the 10 QPIs. In Audit Cycle 2, additional 4 NCGSQ targets were achieved namely- pre-treatment CT/MRI, Histodiagnosis in cryotherapy, histodiagnosis in chemotherapy and MDT discussion.

Conclusions
There has been significant improvement in all QPIs in the management of RCC in Northern Ireland during the audited period. We have achieved NCGSQ quality performance indicator targets in 7 among the 10 QPIs that were audited. Further interventions may be required to achieve targets in QPIs such as Leibovich scoring, pre-treatment TNM staging and prognostic scoring in metastatic RCC.
699 Audit of Post-Splenectomy Patients in Primary Care
Authors: Allen L , Kerley D 
Published: August 2023

Abstract

Aim
To describe the demographics of a large general practices post-splenectomy patient population (including sex, age, and indication for splenectomy), and audit of cohort's care against national immunisation and antibiotic prophylaxis guidelines.

Method
All adult patients registered with the practice who had undergone surgical splenectomy were included. Included patients’ medical records were reviewed and data including sex; age; date and indication of splenectomy; immunisation history; and drug history were collected.

Results
Fifteen of approximately 13,000 registered patients were coded for having previously undergone surgical splenectomy. The main indications included trauma; haematological disease; major intra-abdominal resection. Patient cohort were of an older patient population (mean age 69) having undergone splenectomy several years previously (mean 39 years ago). Three patients had outstanding pneumococcal vaccine in the past five years, however there was 100% compliance with annual influenza vaccine. All patients had received a minimum of two COVID vaccinations. Variation in prescribed phenoxymethylpenicillin dose, with two patients on incorrect antibiotic prophylaxis, and four patients without antibiotic prophylaxis.

Conclusions
Despite our small patient cohort, this audit highlighted variation and deficiencies in patient care, and has led to a recall of patients with outstanding pneumococcal vaccination and review of antibiotic prophylaxis offered to patients. Additionally, there is no national recommendation that post-splenectomy patients should be offered an annual COVID booster. We recommend that this is reviewed urgently by public health officials due to an increased risk of secondary pneumococcal infection with COVID infection, which may be life-threatening.
876 Are Patients Presenting Acutely with Renal Tract Calculi Routinely Given Dietary Advice?
Authors: Jeffery H , Sharma V , Hosny M 
Published: August 2023

Abstract

Aim
The risk of formation of renal calculi can be reduced by making changes to diet and fluid intake. NICE recommend that dietary advice is given to all patients presenting with renal tract calculi either at presentation or prior to discharge. The purpose of this study was to assess patients’ current knowledge and whether provision of the BAUS leaflet can improve this.

Method
At a district general hospital, patients who have had acute presentations with ureteric calculi who are conservatively managed are followed up in telephone ‘hot clinic’. Over a 3-month period, prior to clinic attendance, patients were invited to complete a questionnaire. Inclusion criteria: adults with an isolated presentation who are not high-risk stone formers.

Results
Of the 59 patients who attended seven clinics, 44 completed the questionnaire (70% male, mean age 46 (22, 83)). Only 10 (23%) of the patients recalled being given dietary advice at initial presentation, two of whom were given written advice. Thirty patients were aware that diet can impact on stone formation, however only 13 (30%) and 21 (48%) were aware that dietary protein and salt respectively can impact on stone formation. Knowledge of recommended fluid intake was good, with 31 (70%) correctly identifying 2-3 litres as adequate and only 2 (5%) stating that &lt;1 litre is adequate.

Conclusions
With the exception of fluid intake, patient knowledge of dietary advice for stone formers is poor, due to lack of education provided at initial presentation. Educative measures and signposting to BAUS-approved resources may reduce risk of future stone formation.
958 A Study on Electronic Treatment Escalation Plan (TEP) Forms Completion and Compliance
Authors: Pattnaik S , Zarifian A , Punwar S , Sidhu G A 
Published: August 2023

Abstract

Aim
Establishing a Treatment Escalation Plan (TEP) allows doctors to discuss and record patient preferences in advance, in addition to cardiopulmonary resuscitation (DNA-CPR), but also for various aspects of emergency care and treatment.This study examines the overall rates of TEP form completion, as well as completion within 48 hours of the patient's hospitalization, as observed in routine practise at a DGH.

Method
This study was conducted utilising PDSA (Plan-Do-Study-Act) cycles and a cross-sectional methodology, auditing all adult in-patients admitted to the hospital for Orthopaedic surgery.The first cycle occurred in March 2022, followed by interventions in the form of an institutional algorithm, and the second cycle followed in November 2022.

Results
In the first cycle, 69.5% of patients had a completed TEP form, with 47.8% filling one within 48 hours of admission.It took an average of 4.4 days to complete, with 3.2 overrides. Following intervention and discussion in departmental meetings, 88.2% of tasks were completed, with 35.2% ended within 48 hours. Average days rose to 3.7 days, and overrides fell to 1.3 times. A questionnaire developed for the juniors to ask them about their reasons for noncompliance, and it was realised that the majority of them were concerned about the legal ramifications, correspondence with the patient and family, and a small percentage were due to a lack of time.

Conclusions
When juniors are fully informed of the technique to complete TEP forms, completion rates increase significantly. The process would be maintained under control by regular audits and training for rotating juniors.
998 Distal Radius Fractures – Assessing Time to Surgery
Authors: Taiwo B , Menyah E , Garcia S 
Published: August 2023

Abstract

Background
The British Orthopaedic Association Standards for Trauma (BOAST guidelines) recommend that intra-articular distal radius fractures should be operated within 3 days and extra-articular fractures within 7 days of a decision to operate (1).

Aim
The objectives of this audit were to assess compliance with BOAST guidelines for operative management of distal radius fractures within a local trauma unit.

Method
Three audit cycles were completed between 2018 and 2021 over 3 -4-month periods. The second and third cycles were completed after elective orthopaedic cases were moved to an elective orthopaedic centre, and commencement of a weekly half day dedicated hand trauma list. All skeletally mature patients with acute distal radius fractures were included.

Results
Despite the addition of a dedicated hand trauma list and elective services moving to a dedicated site, compliance with BOAST guidelines remained almost unchanged. Compliance was at 100% for extra-articular fractures. However, for intra-articular fractures, compliance only slightly improved from 50 % to 53.3%. The average time to surgery improved from 4.25 days to 3.66 days for intra-articular fractures. Average time to surgery for extra-articular fractures was 3 days. Proposed reasons for delay included lack of trauma theatre time, prioritisation of other urgent cases such as femur fractures and lack of appropriate surgeon.

Conclusions
No distinction was being made to prioritise intra-articular distal radius fractures over extra-articular fractures for surgery. Trauma and Orthopaedic (T&O) staff have been educated and changes made to the T&O department’s trauma database to resolve this.
1002 Outcomes and Documentation of Minor Skin Surgery at a General Practice
Authors: Dawidziuk A , Turner D , Lakasing E 
Published: August 2023

Abstract

Aim
This audit aimed to evaluate outcomes and documentation of minor skin surgery at a general practice. The basis of the audit was the National Health Service Directed Enhanced Service Specification for Minor Surgery 2021-22 (Minor Surgery DES SLA 2021/22).

Method
The scope included all minor surgery procedures coded as incisions and excisions on the EMIS electronic patient records system carried out at the practice between 25th January 2021 and 25th January 2022. All included records were evaluated for documentation of written consent, comprehensive surgery note, complications, all excised material sent for history, histology results recorded, malignancy reported on histology, and accordance of clinical and pathological diagnoses. The audit standard was set at 80% by consensus of senior clinicians.

Results
The initial search yielded 104 patient records. Following deduplication, 100 cases were included in the audit (8 incisions, 92 excisions). 86% had signed written consent and comprehensive note uploaded to the electronic patient records system (86/100). Complications, including infection, were recorded in 10% of cases (10/100). 92% of cases had all excised material sent for histology and results recorded on the electronic system (85/92) with some material sent in 100% of excisions (92/92). No malignancy has been reported on histology results. The accordance of clinical and pathological diagnoses was confirmed in 79% of excisions (73/92).

Conclusions
Minor skin procedures completed in the evaluated period met the audit standards. Minor surgery documentation could be further improved by introducing a dedicated electronic note template.