bluuebunny/crossref_metadata_2025_split huggingface dataset:
1262 The Relationship Between Eye Dominance and Congenital Limb Absence: A Retrospective Study
Authors: Brown S , Lam W , Hooper G 
Published: August 2023

Abstract

Aim
Congenital limb absence, the absence of one or more limbs present at birth, is a rare but potentially debilitating condition. Previous research has suggested that there may be a relationship between eye dominance and the development of congenital limb absence, but this relationship has not been extensively studied. In the general population, 35-56% of left handers are left-eye dominant and 62-73% of right handers are right-eye dominant. The aim of this retrospective study is to explore the relationship between eye dominance and congenital limb absence.

Method
Medical records of individuals with congenital limb absence from between May 1995 and March 2002 were reviewed, and eye dominance was determined through the use of standardized eye dominance tests. A multivariable logistic regression was developed to determine the effect of limb deficiency laterality on eye-dominance.

Results
A total of 81 patients were eligible for inclusion in the study with a median age of 25 (IQR = 20). 54.3% (n = 44) of the patients were female. Laterality of limb absence was 27:54 (Left:Right). In our study group, 81.5% of left-hand dominant patients were left eye dominant. 83.3% of right-hand dominant patients were right eye dominant. Patients were more likely to be right eye dominant than left eye dominant (OR 22.39, 7.02-85.80, p&lt;0.001).

Conclusions
This study suggests that there may be a potential link between eye dominance and the development of congenital limb absence. Further research is needed to fully understand this relationship and its potential implications for the prevention and management of congenital limb absence.
1276 The Impact of Low BMI on Patient Reported Satisfaction Following Deep Inferior Epigastric Perforators Flap Breast Reconstruction in a National Breast Cancer Centre in the Republic of Ireland
Authors: Dhannoon A , Sheahan C , Christodoulides N , Marino S , Martin-Smith J 
Published: August 2023

Abstract

Introduction
Low-BMI patients are candidates for both implant and free autologous tissue breast reconstruction. However, deep inferior epigastric perforators (DIEP) flaps are not a popular option among thin women. The objective of this study was to evaluate patient reported outcomes among this patient’s population.

Method
A retrospective chart review was conducted for all the DIEP-based reconstruction performed over a five-year period between June 2016 and June 2021. Inclusion criteria included patients with BMI &lt; = 25. Data collection included patients’ demographics, timing of surgery, laterality, number of pedicles, irradiation, complications and adjustments thereafter. After Ethical approval, patients were contacted to assess post-operative satisfaction using the Breast-Q ®.

Results
During the study period, 169 DIEP flap-based reconstruction were performed, a total of 59 patients fell in the low BMI category. Twenty-seven patients had immediate reconstruction and only 2 patients had bi-pedicled flap. The Average age was 48.8 years and average was BMI 23.3. The majority of our patients were non-smoker (n = 57) and didn’t receive adjuvant radiation (n = 43). Only 32.6% (n = 15) had adjustment. The unilateral reconstruction patients made 93.0% (n = 14) of those requiring adjustment with 60% of them (n = 9) undergoing lipofilling. The total response rate to the Breast-Q survey was 79.6% (n = 47). Overall Breast-Q scores showed high satisfaction with breasts with high overall levels of psychological, sexual, and physical wellbeing.

Conclusions
DIEP flap-based reconstruction was demonstrated to be a safe and aesthetic reliable procedure in our cohort, yielding high level of psychological, sexual and physical wellbeing.
35 Enhanced Vetting of Urology Referrals in NHS Lanarkshire
Authors: Rutherford G , Tan L J , Amer T 
Published: August 2023

Abstract

Aim
There is an unmatched need for outpatient clinic appointments across all specialties in the NHS. We aimed to reduce unnecessary clinic appointments within the Lanarkshire Urology Department and thus allow timely access to outpatient appointments for newly referred patients with greater clinical need.

Method
Following a successful pilot in December 2018 all referrals to Lanarkshire Urology department underwent an enhanced vetting process by a consultant urologist with particular attention to:Detailed review of electronic records and imagingBooking of scans/ repeat blood tests prior to consultationsSignposting to more appropriate services such as the community continence clinic were indicatedWritten advice, with returned referrals giving clear guidance and evidence-based recommendations where appropriate
Subsequently 3 phases have been completed
Phase 1: June-December 2019.
Phase 2: June-December 2020.
Phase 3: January - November 2021

Results
Pilot and Phase 1
6.3% of referrals were clinically canceled with the referrer being sent case specific clinical advice. This increased to 9.5% in phase 1.
Phase 2:
There were 3012 outpatient urology referrals between June and December 2020.
762 patients were vetted as clinically canceled, an 87% increase from 2019, reducing the number of clinic appointments required by 25%.
Phase 3:
9634 patients were referred between January 2021 and November 2021, 15.8% (n = 1484) vetted as clinically canceled/ advised only. Furthermore, 548 patients were taken straight to test decreasing duplicate appointments.

Conclusions
We have recognized that vetting is a factor that, done well, can mitigate unmatched demand in outpatient services.
123 Optimising Pre-Operative Intravenous Fluids to Reduce the Incidence of Acute Kidney Injury in Hip Fracture Patients
Authors: Ng N , Smith T , Leow J M , Williams M 
Published: August 2023

Abstract

Aim
Acute kidney injury (AKI) in hip fracture patients is associated with increased morbidity, mortality, and hospital stay. Local policy recommends 500ml of Plasmalyte on admission to the Emergency Department (ED), followed by another 500ml at 100ml/hr. Subsequently, patients without AKI should receive maintenance fluids until post-operative oral fluid intake is adequate. IV fluid (IVF) prescriptions in line with local policy were defined as ‘adequate’.

Method
Three prospective audits were undertaken with interventional measures deployed between cycles. Data collected included blood results, IVF received, past medical history, and the pre/post-operative incidence of AKI. Interventions include an ED proforma used as an admission checklist and educating ward doctors with a narrated video and posters.

Results
None of the twelve patients in the first cycle received adequate IVF. The second and third cycles had twenty-seven and twenty-eight patients, respectively. Between these cycles, ED’s IVF prescription adherence improved from 37.0% (10/27) to 46.4% (13/28). On the wards, IVF prescription adherence significantly improved from 33.3% (9/27) to 78.5% (22/27). Pre-operative AKI was 3.7% (1/27) in the second cycle and 0% (0/28) in the third cycle. Post-operative AKI was 3.7% (1/27) in the second cycle and 7.1% (2/28) in the third cycle. None of the post-operative AKI patients received adequate IVF. The third cycle showed that the primary Plasmalyte and secondary Plasmalyte were prescribed appropriately in 57% and 50% of patients, respectively.

Conclusions
Our interventions successfully improved IVF prescriptions on the wards. However, adherence can be further improved to local policy to reduce the incidence of AKIs.
316 The Impact of a Surgical Same Day Emergency Care (SDEC) Unit
Authors: Lukaszewicz A , Linganathan S , Morris C , Strong P 
Published: August 2023

Abstract

Aim
SDEC units are part of the NHS long term plan. It marks a shift from assessment units to tailored emergency care hubs providing genuine dual assessment and treatment. Its aim is to provide optimal care for patients in a timely manner by the appropriate teams, enabling reduced time to emergent treatment, reduced pressure on other acute services and shorter inpatient stays. This is ever more pertinent in the modern, post-pandemic NHS with staffing and funding challenges combining with record numbers of expectant patients awaiting urgent operations. This QIP aims to investigate one such unit’s effectiveness.

Method
SDEC surgical admissions data was collected from the online system BIS or from the clinical notes between September 2021-2022. This was then graphed on excel and analysed.

Results
Pertinent findings include: 47% drop in ED surgical presentations. 66% surgical emergency attendances seen in SDEC (43% prior to SDEC). Decision to admit time reduced by 150 minutes. Median time from arrival to discharge reduced by 7 hours.

Conclusions
This SDEC unit has had a positive impact on ED workload and improving decision making & throughput of surgical patients. As well as supporting previous studies on SDEC benefits this model works for all surgical specialties. It is also objective and repeatable, allowing like-for-like comparison. Limitations include short study period, and lack of patient satisfaction assessment. It is also unclear which specific elements of SDEC model have had the beneficial effects.
342 Procedure Room Lists for Core Trainees
Authors: Burrows A , Singh R , Read J 
Published: August 2023

Abstract

Aim
To reduce the waiting list times for local anaesthetic (LA) “lumps and bumps” in our trust and simultaneously increase our junior surgical trainees’ logbook numbers and confidence; by piloting a trainee led procedure room list during covid recovery.

Method
Clinic letters for the 49 patients on the waiting list were vetted for appropriate cases by the firm core trainee (CT) and registrar. The CT liaised with supervising colleagues, admissions, and management to plan and complete ad hoc “procedure room” lists in free slots of the existing theatre timetable.

Results
From 08/09/22 to 01/12/22 (12 weeks), 27 procedures were completed by junior surgical trainees over seven sessions. The trust’s waiting list for benign local anaesthetic procedures decreased from 49 weeks to 1 week. Trainee logbook numbers for these procedures increased nearly 20-fold compared to similar 12-week periods earlier in training. Comparison in confidence levels of the trainees, as assessed by a questionnaire, increased markedly from the beginning to the end of the project, in suturing, diathermy, and excision of benign subcutaneous lesions. There were no complaints or adverse events.

Conclusions
This quality improvement project was led from inception to completion by surgical trainees and played a significant part in the trust’s COVID recovery. Trainee delivered “lumps and bumps” lists can be introduced safely within the envelope of existing resources and can lead to improved trainee operative numbers and confidence. We are working to create a formal pathway for these patients and embed this into the local core training curriculum.
347 General Surgery Ward Round Documentation: A Quality Improvement Project
Authors: Dyer M , Mazumdar E , Abdelkarim M E A , Morgan R 
Published: August 2023

Abstract

Aim
To improve the rate of inclusion, and quality, of important clinical details in the ward round documentation of General Surgery inpatients at a district general hospital.

Method
A 15-point ward round checklist was created, containing clinical details which were considered appropriate to be included in all wards round entries. An initial audit of 71 ward round entries was performed, assessing their compliance to this checklist.
Following this, a ward round proforma was created and put into use. One month later, 106 wards round entries were sampled for a repeat audit, 85 of them having used the ward round proforma (80.2% compliance). These 85 entries were then analysed for compliance against the checklist, and results compared to the first cycle.

Results
Use of the proforma demonstrated improvement in 11 out of 15 checklist components, with one component (a documented management plan) remaining at 100% compliance. The proforma achieved an 100% compliance of 3-point patient identification (+43.7%), with dramatic improvements in the documentation of NEWS score/observations (+22.5%), medication review (+26.7%), thromboprophylaxis review (+53.4%), examination findings (+45.3%) and escalation/DNACPR status (+37.7%).
The 3 components where performance declined were the name of the ward round lead (-8.5%), date (-2.4%) and time (-10.6%), most likely due to design of the proforma which has been rectified and will be reaudited to ensure improvement.

Conclusions
Using a ward round proforma greatly improves consideration and documentation of important clinical details on ward rounds. This has positive implications for patient safety and facilitates the subsequent ongoing care of the patient.
363 The Use of Printed Radiographs to Document Dental Extractions for Alveolar Bone Graft Patients
Authors: Gkorila A , Langford M , Bussell M , Fallico N 
Published: August 2023

Abstract

Aim
Recent cases of additional operations had to be offered prior to an alveolar bone graft (ABG) to complete dental extractions. Appropriate planning is important to avoid multiple GAs or the potential extraction of a wrong tooth. This quality improvement project was performed to assess and improve our practice.

Method
As a gold-standard, all dental extractions should be correctly identified and documented on printed orthopantograms (OPG) or upper standard occlusal (UOS) radiographs at the time of ABG planning. Documentation should include their timing (pre- vs intra-operative), a cross tooth marking on the radiograph, signed by two consultants, and filed with the consent form.
In the first audit cycle we completed retrospective data collection of the above parameters for all ABG clinic patients between June and August 2021. After discussion with the stakeholders and implementation of changes, prospective data was collected for the second cycle, from October to December 2021.

Results
The documentation of the date of the OPG and UOS improved from 26.6% (4/15) to 100% (11/11). For 1 of the patients in the 2nd cycle, no OPG was done, as the patient's dental development didn't justify it. For the preoperative extraction cases, the presence of printed OPG in file increased from 53.8% (7/13) to 100%, marking of teeth improved from 57.1% (4/7) to 83.3% (5/6), and filing of the consent forms remained stable around 70%.

Conclusions
Adherence to the gold-standard was improved in most aspects as a result of this quality improvement project. Further changes will be introduced to achieve 100% compliance rate.
378 Improving Opioid Stewardship in General Surgical Practice
Authors: Reid R , Vijayagopal K , Digne-Malcolm H , Khan J S , Butler R , Peters P , Htet W , Mohamed R , Ahmed M , Wilson J , Magee C 
Published: August 2023

Abstract

Aim
The last 30 years has demonstrated a steady increase in drug-related deaths, with opioids implicated in at least 2,219 deaths in 2021 in England and Wales1. Inpatient opioid prescribing in surgery has been demonstrated to correlate with long term use post-discharge2. We aim to improve opioid stewardship at our DGH to reduce ‘opioid-load’ in the community, thereby reducing likelihood of long-term post-operative use.

Method
Intervention included teaching for junior doctors, audit meeting presentation and posters designed collaboratively with acute pain team. Prospective data collected for 92 patients discharged from general surgery from October 2022 and compared to previous data pre-intervention from June 2020. Opioid prescriptions were converted to Milligrams of Morphine Equivalence (MMgEq) for analysis.

Results
Following intervention, max average 58.64 MMgEq/day compared to 85.88 MMgEq/day previously. Max PRN prescription now 49.77 MMgEq/day compared to 57.18 MMgEq/day. Increased involvement of acute pain team (15.9% to 20%) and improved use of multimodal analgesia (PCA - 3% to 13%, NSAIDS - 2% to 16.5%, rectus sheath blocks – 1% to 4.2%). Discharge prescribing also improved; only 57.6% discharged with opioids, 89% had documented plan for GP and 49% had specific duration.

Conclusions
Our results demonstrate marked improvement in surgical opioid prescribing. There is potential for further improvement including introduction of opioid misuse risk calculator and formalising opiate prescribing guidelines in surgery.
502 A Retrospective Review of Laparoscopic Colectomies Informed Consent Documentation, with a View of Standardisation Are Patients Properly Informed?
Authors: Laulloo S , Muhammad K , Abduljabbar M , Ahmed G , Perakath B 
Published: August 2023

Abstract

Introduction
Shared decision-making and consents are fundamental to good medical practice and are paramount to our surgical practice. A lack of clear recorded information given to patients about the surgical procedure, associated risks and potential complications can cause harm. Landmark cases such as Montgomery vs Lanarkshire Health Board, emphasized the importance of accurate and informative consent forms.

Aim
To improve the quality of our consent forms. To standardize our consent forms for laparoscopic colectomy resection surgeries performed at The Department of General Surgery at Wye Valley NHS Trust. To produce a model consent form to reduce future medicolegal issues related to poor documentation.

Method
We identified 22 common risks and complications associated with any laparoscopic colectomy surgery. Consent forms were analysed for documentation of: Demographics, risk factors, clear handwriting; Known relevant risk factors associated with the procedure; Benefits and any additional procedures required and Name & grade of healthcare professional.

Results
The most common complications mentioned across the consent forms were Anastomotic leak /Collection (94%), Wound infection, Bleeding, and DVT/PE (90%). Complications like post-op pain, post-op ileus, stoma complications, iatrogenic bladder/ureter injuries, and mortality were under-recorded. As a result, the quality of our consent forms and information provided to our patients is widely variable.

Conclusions
Proper completion of consent forms is crucial. Introducing a modified consent form with pre-filled risk factors/complications will allow for more accurate consent form completion ensuring relevant complications are discussed with patients.
573 Proforma for Referrals to the Paediatric Surgery Ward from General Practice (GP) Surgeries and Urgent Care Centres for Foundation Year One (FY1) Doctors
Authors: Kalu U A , Abu-Suleiman A , Edet G , Quinn C , Fleet M 
Published: August 2023

Abstract

Introduction
The foundation year one (FY 1) doctors hold a bleep and receive referrals from primary care centres especially from the General Practice (GP) surgeries and Urgent Care centres. For many FY 1 doctors, this job may be their first experience in the NHS in taking referrals and it could be quite challenging to take a good referral from primary care centres in the NHS. This was the basis to conduct this quality improvement project (QIP) to help the FY 1 doctors in taking good primary care referral documentation.

Aim
To develop a primary care centre referral proforma as a guide for the FY 1 doctors in taking referrals and to assess the junior doctors and other ward staff satisfaction in using the proforma.

Method
This QIP was registered and approved by the Continuous Quality Improvement Team of Hull University Teaching Hospital NHS Trust. This was a prospective study with designed proforma for FY 1 doctors to be used following primary care centres referral to the Paediatric Surgery ward.

Results
There were 38 primary care referrals between 16th October 2022 and 20th December 2022 with 30 referrals from the GP surgeries and 8 referrals from the Urgent Care centres. The overall satisfaction was excellent with the use of the designed proforma by the FY 1 doctors and other ward and we had 100% completion in filling in the designed proforma.

Conclusions
A well designed referral proforma could improve the confidence and quality of referral documentation from primary care centres by FY 1 doctors.
666 Improving Consent Form Completion Rate and Quality in Plastic Surgery
Authors: Zhao Z , Serle J , Kiakou M , Leong S , Armstrong A 
Published: August 2023

Abstract

Aim
The consent form is a medico-legal document which seeks to reflect the quality of the consenting process. We aim to audit and improve the quality and completion of surgical consent forms in a plastic surgery department in a major trauma centre.

Method
Retrospective review of Consent Form 1 for surgical procedures completed in May 2022. 3 aspects were audited: legibility, information sharing, and seeking consent. An educational poster was created as the intervention. The audit was repeated in October 2022. A survey was sent to obtain clinicians' experience to compare to the results.

Results
The first cycle audited 62 consent forms: 79% were completely legible with no abbreviations. 98% contained 3 patient identifiers. 83% had completely legible benefits and risks documented. 71% had the information of the consenting clinician clearly documented. 3.3% had documented if a carbon-copy was offered to the patient.
Post-intervention, 54 consent forms were audited. 100% were completely legible with no abbreviations. 100% contained 3 patient identifiers. 91% had completely legible benefits and risks documented. 93% had the information of the consenting clinician clearly documented. 39% had documented if a carbon-copy was offered to the patient.
10 clinicians responded to the survey: 70% described having little to no formal training in completing consent forms; 60% noted that they have learnt through observing others.

Conclusions
A simple intervention is enough to significantly improve the quality of documentation of consent forms. Greater education of how to correctly complete the consent form is important in the education of a surgeon.
765 Improving the Assessment of Patients Post-Angioplasty: A Quality Improvement Project in a District General Hospital
Authors: Shah S , Mohammed E 
Published: August 2023

Abstract

Aim
Complications post-angioplasty are rare and include haematomas, haemorrhage, and acute limb ischaemia. National guidelines recommend patients should be kept in an area where limb perfusion and complications can be assessed, but doesn’t detail what this encompasses. Others have suggested this could include examination of pulses, limb perfusion and an ankle brachial pressure index (ABPI). This QIP aimed to improve the examination of patients’ post-angioplasty and develop internal guidelines to support this.

Method
Data was collected retrospectively between 01/12/2021 – 18/03/2022 and 25/03/2022 – 31/07/2022 for patients undergoing inpatient angioplasties. Documentation was examined for evidence of assessment of the following domains: 1) Peripheral pulses, 2) Wound site, 3) Haemodynamic stability, 4) Limb perfusion, 5) ABPI, 6) Decision regarding anticoagulation, and 7) Same day assessment. A teaching session was delivered to doctors teaching them how to examine these patients, use a doppler and measure an ABPI. We re-audited and created guidelines which were displayed on the surgical wards.

Results
There was a notable improvement in the examination of peripheral pulses (33% to 100%), wound sites (47% to 93%), limb perfusion (40% to 93%), same day review (73% to 86%) and decisions regarding anticoagulation (60% to 71%). Haemodynamic stability and ABPI remained unchanged.

Conclusions
We show that teaching juniors how to examine patients’ post-angioplasty improves the assessment of these patients. This is important for early identification and treatment of complications. Though this was carried out in a small district general hospital, it also highlights the need for more detailed national guidance.