bluuebunny/crossref_metadata_2025_split huggingface dataset:
960 Referral Documentation in Orthopaedic Trauma
Authors: Rehman H , Lim JW , Cullen F 
Published: November 2022

Abstract

Aim
We aimed to measure and improve documentation and decision making for on-call Orthopaedic Trauma referrals.

Method
Documentation for all referrals to the Orthopaedic Trauma Service, at a major urban trauma centre, in Scotland, over a defined period was reviewed. The audit conducted between February 2020 and November 2021. Documentation was scored. Two further audit cycles were performed after the introduction of an electronic “contact note” system.

Results
There was a dramatic improvement between cycle 1 and cycle 3 of available documentation 76% versus 98%. Documentation was available on the day of referral for 60% of cases reviewed by cycle 3 versus 30% for cycle 1; 98% complete documentation was available by day 2 during cycle 3. The system was rated high satisfactory by 90%% of users.

Conclusions
Complete documentation was more widely and more quickly available after the introduction of an electronic note keeping system. The system was user friendly and rated high satisfactory. We believe the system improved patient safety.
1002 Improving the Medical Student Experience of Trauma and Orthopaedic Education – a Quality Improvement Project
Authors: Khanom S , Nebo V , Noton T , Garlick Ni , Maruthainar N 
Published: November 2022

Abstract

Aim
The medical student experience of clinical placements is closely linked with quality of teaching, varied educational opportunities and sense of belonging within the team. Surgical rotations such as Trauma and Orthopaedics (T&O) have a stereotype for being challenging. At a London teaching hospital student satisfaction of T&O placements was low (8% satisfaction) as assessed by feedback. This quality improvement (QI) project aimed to improve the quality of educational experiences and overall student satisfaction in T&O.

Method
Student feedback from end of placement evaluation forms from academic years 2016–19 was reviewed. A QI driver diagram was created based on the themes raised in the feedback. These were 1) formal teaching, 2) structure and organisation, 3) curriculum content and 4) student engagement and belonging. Each theme was subdivided into multiple achievable strategies to improve student experience while on T&O placements. This included allocated clinic and theatre sessions, bedside teaching, named tutors, curriculum map, WhatsApp communication and a dedicated clinical teaching fellow in the department.

Results
As a result of the implemented QI strategies, student satisfaction improved over the subsequent semesters to 100%, 89%, 100% and 75%, with a greater number of students providing feedback.

Conclusions
The project achieved greater student satisfaction of T&O education and improved the student experience of surgical placements. It also validates student feedback as a valuable tool in developing surgical education.
1003 QIP: Improving Provision of Driving Advice Post Abdominal Surgery
Authors: Ahmed F , Dalip A , Agrawal A 
Published: November 2022

Abstract

Aim
The aim of this QIP was to improve provision of driving advice post abdominal surgery. The royal college of surgeons recommends that before resuming driving after surgery, patients should be free from the sedative effects of any painkillers they may be taking, and they should be comfortable in the driving position and be able to safely control their car, including freely performing an emergency stop.

Method
Relevant discharge summaries from the general surgical department at the QEQM hospital in Margate were screened from 15/01/2021 to 14/04/2021 (N=61) to assess how well the department provided driving advice. Documentation was found to be 52%. An email was sent to junior doctors outlining aims of the QIP. A second intervention was required following initial minor improvement, with a poster made and emailed to doctors rotating into the general surgical department.

Results
In the first month post intervention, 15/05/21–14/05/21, a minor improvement was seen, with the documentation rate being 57% (N=56). Subsequent poster intervention to new rotating junior doctors markedly improved documentation, with monthly results from 20/08/21–19/12/21 showing documentation rates of 62% (N=86), 73% (N=103), 76% (N=111) and 86% (N=82).

Conclusion
This QIP shows a marked improvement in documentation rates of driving advice post abdominal surgery. Interestingly, it also shows how timing of quality improvement advice can impact departmental outcomes. Newly joining junior doctors presented with the same intervention advice in poster format as leaving doctors were aware from their first day on their surgical rotations of best practice with regards to documenting driving advice.
1026 Good Prescribing Laxatives Practice for Trauma Admissions in Orthopaedic Wards at Altnagelvin Hospital
Authors: Sandhu HS , Safari S , Bonsell L 
Published: November 2022

Abstract

Aim
The aim of this QIP is to firstly increase percentage of T&O admissions to Orthopaedic Wards 23+25 prescribed laxatives by 25% by 1st of December over 1 month and to increase awareness among healthcare staff.

Background
Constipation in elderly during inpatient stay is common, 50% of pts&gt;65years will develop this due to multifactorial reasons. Correct laxatives are very important to curb this predicament.

Method
These data were assessed over the following criteria, laxatives prescribed on admission, administered following prescription, monitoring bowel output, suppositories prescribed after admission. Following each week QI cycles, appropriate interventions were made to improve the adherence and data was re-measured again.

Results
From Baseline data, only 45% of patient were prescribed laxatives and only 20% patients received the medication initially. Of this group, only 20% pts had suppositories prescribed following admission. Lastly, 40% of patients had Bowel Opened (BO)&gt;3days ago. First intervention was educating all SHOs to ensure patients received prescription on admission. Following this, mainly laxative prescription increased by 40%, and patient received their laxatives by 2% respectively in PDSA 1.
In PDSA 2, we actively ensured educating nursing staff to encourage laxative prescriptions and to inform doctors for patients with Last BO&gt;3days ago for suppositories prescribing. Following this, laxative prescription increased to 80% while 65% pts received their prescription. Only 15% pts had BO&gt;3days too.

Conclusion
Regular laxatives are superior to PRN & Recommended regime is Senna+Lactulose for patient adherence. Additionally, suppositories should be given as STAT rather than Prn as well.
175 Rare Complications and Management of Port Site Hernias (PSH) Following Robotic-Assisted Radical Prostatectomy (RARP)
Authors: Lau A , Aseem R , Shrestha A 
Published: November 2022

Abstract
Robot-assisted surgery has become increasingly prevalent in surgical practice and is very commonly performed in urological cancers especially of the prostate gland. Robotic surgical techniques are safe and reproducible; however, they have their associated complications. Risk factors such as the nature of cancer, learning curve of the surgery, experience of the surgeon and patient characteristics have been implicated for potential complications. Complications can range from bleeding, infection, bowel injury, ureteric and nerve damage. Port site hernias (PSH) are an infrequent complication with a reported incidence varying from 0.2–4.8%. Although uncommon, they can result in high morbidity due to bowel incarceration and strangulation.
We report two cases of PSH from our large district general hospital, both at the supraumbilical port site after robotic assisted radical prostatectomy (RARP). The first case presented with complete evisceration and strangulation of a segment of small bowel and the second with bowel incarceration and small bowel obstruction. Our cases highlight potentially rare but severe complications of RARP that should be promptly recognised and urgently treated to prevent significant patient morbidity and mortality.
177 Robotic Assisted Versus Conventional Unicompartmental Knee Arthroplasty: A Systematic Review and Meta-Analysis
Authors: Kar I , Qayum K , Nawaz G 
Published: November 2022

Abstract

Aim
To compare the robotic-assisted unicompartmental knee arthroplasty (UKA) with conventional UKA.

Method
We systematically searched on four databases till September 2021. The outcomes were pooled as mean difference (MD) or standardized mean difference (SMD) or risk ratio (RR), and 95% confidence interval. We used RevMan to perform the analysis.

Results
There were 22 included studies. There were no significant differences between the robotic-assisted UKA and the conventional one in satisfaction rate (RR=1.05, 95% CI [0.98, 1.14], p=0.19), complication rate (RR=0.62, 95% CI [0.32, 1.19], p=0.15), and range of motion (MD= -0.23, 95% CI [-5.76, 5.30], p=0.93). However, robotic-assisted UKA showed significant favouring in the outliers of limb alignment (RR= 0.46, 95% CI [0.29, 0.74], p=0.001). On the other hand, the conventional UKA had better surgical time than the robotic assisted one (MD=20.89, 95% CI [11.87, 29.90], p&lt;0.00001).

Conclusions
There were mainly no significant differences between robotic-assisted UKA and the conventional one in several outcomes such as the satisfaction rate, complication rate, and others. However, robotic-assisted UKA significantly favoured outliers of tibial alignment, and outliers of limb alignment, but prolonged surgical time than the conventional group.
59 Associations of Biological Sex with Clinicopathologic Features of Cutaneous Melanoma
Authors: Tay T , Oudit D , Cook M , Green AC 
Published: November 2022

Abstract

Aim
It is commonly known that women have better prognosis than men after diagnosis of primary cutaneous melanoma. However, few studies have investigated whether histopathological prognostic factors are associated with this difference. This study aimed to investigate if there were sex-specific differences in prognostic features of primary melanoma at time of diagnosis in a large clinical series.

Method
This was a records-based observational study of unselected patients treated for melanoma in a major tertiary oncology centre in the United Kingdoms, 2002–2016. Prognostic features (age at diagnosis; thickness of primary melanoma; ulceration and mitotic count) were extracted from histological reports and sex-specific differences tested for significance using X2 test.

Results
Among 1323 melanoma patients of median age 61 years (range 15–99), and roughly equal proportions of males (640, 48%) and females (683,52%), females had significantly earlier age of presentation on average than males (58 vs 64 years) (p&lt;0.001). Comparing Breslow thickness of &lt;2mm vs ≥2mm, significantly more females (414, 67%) than males (282, 55%) had melanomas &lt;2mm (p&lt;0.001). Other key histopathological factors namely presence of ulceration (p=0.073) and mitotic rate (p=0.618) were not significantly different by sex.

Conclusions
We found that female melanoma patients presented at an earlier age and with thinner primary melanomas than males, but mitotic rate (speed of tumour growth) was not significantly different. These data suggest that females’ better prognosis is explained by their tendency to present earlier with suspicious skin lesions than males.
221 Lynch Syndrome - Do We Really Screen for It?
Authors: Rantos I , Leow TH , Sekyi-Djan MN 
Published: November 2022

Abstract

Aim
Firstly, assess the compliance of our Trust with the DG27 NICE Guidelines (2017) recommending universal screening of patients with Colorectal Cancer (CRC) for Lynch Syndrome (LS), using Immunohistochemistry or Microsatellite Instability testing. Secondly, provide a cost estimate for the Trust to implement universal screening for LS.

Method
Retrospective data collection for all CRC resection specimens reported by the Trust's Pathology Lab in 2019, and check of pathology reports, Clinic letters, and lab results through the Trust's electronic system for screening for LS. Cost estimates were calculated using information from the Histopathology Department and similar Audits by other NHS Trusts.

Results
From the 361 colorectal resection specimens examined at the Trust's Pathology lab, 340 were not screened for LS (NICE Guidelines compliance = 5.8%). Of the 21 screened, 12 patients did not have LS, and for 9 screening was not completed. By categorising the patients into groups by age, location of cancer, and presence of synchronous or metachronous cancers, we found that there was no consistent rationale behind screening (i.e., patients with phenotypical characteristics traditionally related to LS were not screened). We estimated that universal LS screening would cost the Trust approximately £25,000 annually.

Conclusions
There is extremely poor compliance with the NICE Guidelines in a Trust with one of the highest numbers of CRC resections annually. Even the Amsterdam Criteria are not used to screen patients for LS. Screening could change the surgical and oncological management of the patients and also suggest different surveillance and prophylaxis for the affected family members.
595 Outcomes of Two-Stage Revision Surgery of Oncology Endoprostheses for Prosthetic Joint Infection
Authors: Adlan A , McCulloch R , Evans S , Parry M , Stevenson J , Jeys L 
Published: November 2022

Abstract

Aim
We aim to report the outcomes of two-stage revision surgery to eradicate periprosthetic joint infection (PJI) of endoprostheses in orthopaedic oncology.

Method
A retrospective review of 44 patients who underwent two-stage revision surgery to eradicate PJI between 1999 and 2018 was conducted at a single tertiary orthopaedic oncology centre. The patients mean age was 36.1 years (12–78). The sites of prostheses were distal femur in 50%, proximal femur in 11.4%, proximal tibia in 36.4% and total femur with proximal tibia replacement in 2%. The mean follow-up period was 6.9 years (range 0.4–19 years).

Results
The overall rate of infection eradication for the patients was 95.2% at 2 years (95% CI 89–100%) and 79% (95% CI 67–93%) at 5 years. Amputation free survival was over 100% at 2 years and 88% at 5 years (95% CI 78–99.8%). There was no difference in the incidence of reinfection recurrence and amputation of patients with silver-coated implants. Coagulase-negative staphylococcus was the most common microorganism, isolated in 21 patients. Infection was successfully eradicated in 54.5%. Polymicrobial infection was recorded in 18%. Multi-drug resistance (MDR) organisms were recorded in 48% of the cohort.

Conclusions
MDR and polymicrobial organisms are common in orthopaedic oncological patients with lower infection clearance rates than the primary arthroplasty group. The increased attempts at limb salvage to treat infection may explain lower infection-free survival compared to previous series at the same centre, which reported higher rates of primary amputation to treat infection as their initial management.
892 Quality of Life After Pancreaticoduodenectomy
Authors: Russell J , Guildford N , Karavias D , Hamady Z 
Published: November 2022

Abstract

Aim
Pancreaticoduodenectomy (PD) can severely impair quality of life (QOL) and alter normal activities. The European Organization for Research and Treatment of Cancer QOL questionnaire (EORTC QLQ-C30) is an integrated system for assessing QOL in cancer patients. The aim was to evaluate the QOL outcomes for patients who undergo PD over a six-month period peri-operatively.

Method
EORTC QLQ-C30 (v.3) and pancreas-specific (PAN26) questionnaires were offered to patients who underwent PD between July 2018 and March 2019. Patients were invited to complete the questionnaire three times (1–2 weeks pre-operatively, 2–6 weeks post discharge, and 6–8 months post-operatively. Patients were excluded if they did not complete &gt;50% of the questions for at least two consecutive questionnaires. Scores were calculated in accordance with the EORTC QLQ-C30 (version 3) core questionnaire manual. Data was analysed using Cohen's effect size and one way analysis of variance (ANOVA).

Results
A total of 21 patients were included. Overall QOL was reduced post-discharge (mean score 70.4 (±23.6) vs. 54.6 (±21.0), d=1.628, p=0.0412), however, there was no difference between QOL scores pre-operatively and after 6 months. There was a significant difference after 6 months for physical (mean score 98.4 (±9.6) vs. 85.2 (±14.6), d=1.068, p=0.0017) and role (mean score 92.1 (±17.2) vs. 63.9 (±28.7), d=1.1919, p=0.0005) function-related questions. Reduced appetite, diet restriction and pain were worse following discharge but improved significantly after six months.

Conclusions
The results from this study suggest that whilst certain symptoms and functional impairment is common following PD, overall QOL returns to pre-operative levels for most patients.
131 Sleeping It Off - Are Hospital Wards Too Noisy to Allow Patient Recovery?
Authors: Reid M 
Published: November 2022

Abstract

Aim
Increased overnight noise levels are known to stimulate the release of multiple stress hormones and negatively impact upon objective and subjective sleep quality. Increasing levels of noise impairs physical and psychological recovery, and has been shown to slow wound healing, increase complication rates, and lengthen hospital admissions. Noise levels are therefore an important component of post-operative care and recovery. The purpose of this study is to document the actual noise levels experienced by patients overnight and analyse the sources of noise.

Method
Firstly, five-minute recordings were made during four separate hours throughout the night on two wards - one paediatric and one adult. Secondly, researchers described and categorised the sources of noise.

Results
The World Health Organisation (WHO) has recommended that average overnight noise levels in hospitals should not exceed 35 dB. The average recorded on the paediatric and elderly ward was 42.27 dB and 43.91 dB, with peak noise levels of 93.65 dB and 97.01 dB respectively. In every five-minute recording, there was at least one sound louder than 67 dB. Researchers identified multiple avoidable and non-avoidable causes.

Conclusions
The average noise level was significantly greater than the WHO recommendations. Every five-minute recording contained peak sounds of significance. Such noise levels have been linked to poor sleep, increased stress hormone release, delayed wound healing, and an increased post-operative recovery time. Many feasible solutions to address the avoidable causes of these sounds are identified. Addressing this issue is important for both medical and surgical units and is likely to improve patient outcomes.
259 Postoperative Music, a Non-Pharmacological Pain Relief: A Randomized Controlled Trial
Authors: Aghakhani N , Ewalds-Kvist BM , El Boghdady M 
Published: November 2022

Abstract

Aim
Postoperative moderate to severe pain disrupts patients’ sleep and affects their quality of life. Non-pharmacologic pain relief such as music therapy were considered beneficial. We therefore evaluated preferred type of music as pain relief in patients with abdominal surgery in a non-UK teaching hospital.

Method
Patients undergoing open abdominal operations were included. Patients with laparoscopic or rectal surgery and/or spinal or epidural anesthesia were excluded. Routine postoperative analgesics were used. Demographic variables were recorded and VAS pain scale (0 – 10 most severe pain) was assessed in first day postoperative. Patients or their relatives gave informed consent.

Results
Sixty patients (Md age 39 years) were included; 30 patients allocated in experimental group who listened to preferred music using headphones (20 min) vs Control group used headphones without music.
Fisher's exact test and independent t-tests were computed. The pain intensity decreased from 6.94 (SD .13) to 6.21 (SD .21) in the control group (n.s,) and in the experimental group from 7.06 (SD .31) to 3.25 (SD .21), (p &lt;.0001, 2-tailed) with no significant difference between the two groups before intervention. Pain intensity in experimental group decreased due to the intervention. There was a significant difference in pain intensity between the experimental and control groups after music therapy (p &lt; .001, 2-tailed)

Conclusions
The patients who listened to preferred music after surgery, experienced less pain compared to their controls. A long-term follow-up with larger sample size may conform the efficacy of post-operative music as a pain-relief in UK settings.
529 Gallstone Disease and the Risk of Cardiovascular Disease – a Mendelian Randomisation Study
Authors: Fairfield C , Drake T , Pius R , Bretherick A , Campbell A , Clark D , Fallowfield J , Hayward C , Henderson N , Iakovliev A , Joshi P , Mills N , Porteous D , Ramachandran P , Semple R , Shaw C , Sudlow C , Timmers P , Wilson J , Wigmore S , Spiliopoulou A , Harrison E 
Published: November 2022

Abstract

Aim
Gallstones present frequently to surgical units and share risk factors with cardiovascular disease (CVD). Little is known about long-term CVD risk or the presence of any causal relationship. The aim of this study is to assess long-term CVD risk in gallstone-carriers and assess causality through Mendelian randomisation (MR).

Method
458,968 UK Biobank (UKB) participants free from baseline CVD were assessed. Cox regression adjusting for gallstones, age, sex, diabetes, smoking, anthropometric data, serum lipids, exercise and diet was conducted to assess CVD risk after 10 years in gallstone-carriers compared to controls. Two-sample MR was conducted with gallstone-susceptibility variants from the UKB and CVD-susceptibility variants from CardiogramPlusC4D in inverse-variance-weighted meta-analysis. Multivariable MR adjusting for lipid-, smoking- and diabetes-susceptibility variants was undertaken.

Results
Risk of CVD was higher in gallstone-carriers than controls (2,579/32,528 [7.1%] versus 23,249/426,082 [5.5%]; adjusted-hazard-ratio 1.48, 95%CI 1.42–1.54). MR demonstrated the opposite, with protective impact of genetic liability to gallstones on CVD (odds-ratio 0.94, 0.89–0.997). Leave-one-out analysis of each variant revealed strongly protective impact of D19H ABCG8 mutation which lowers serum lipids via biliary efflux. Multivariable MR revealed no significant association (odds-ratio 1.02, 0.93–1.11). Univariable MR after excluding all lipid-lowering variants revealed no association.

Conclusions
Gallstone-carriers experience elevated CVD risk partly explained by shared risk factors. MR demonstrated a negative relationship between genetic liability to gallstones and CVD. This was explained by lipid-lowering gallstone-susceptibility variants. Genetic liability to gallstones reduces CVD risk through lowering serum lipids. Gallstones remain a sentinel presentation of CVD risk due to shared environmental but not genetic exposures.