bluuebunny/crossref_metadata_2025_split huggingface dataset:
288 Re-Audited QIP on Accuracy of Documentation in the Surgical Notes and Discharge Letter
Authors: Karki BB , Wolff J , Tsao A , Basamh M , Runau F 
Published: November 2022

Abstract

Aim
To identify and review the discrepancy between the documentation in the surgical operation notes and discharge summaries. To evaluate the surgical operation notes and assess its compliance with the RCS standard.

Method
Prospective audit of 64 General Surgery operation notes and their respective discharge letters was carried out in two cycles from March- June 2021. Royal College of Surgeons England Good Surgical Practise, 2014 was used to audit the general surgery notes. Teaching sessions were carried out after the first cycle for the use of Electronic Operation Notes. Furthermore, comparison of this audit results with the different trust following Electronic Operation notes were carried out.

Results
Operation notes and discharge letters were reviewed on variables like date of procedure, quality of performa based on RCSEng guidelines. There was 50% increase in the use of Typed Operation Notes in the second cycle which showed a significant decrease (almost 50%) in the mentioning of incorrect operation dates. 65% of the handwritten notes were not comprehensive enough or legible. However, Electronic operative note had significant adherence to the RCS guideline. When these data were compared to the other trust using Electronic Operation Notes all the highlighted issues were found in a negligible ration.

Conclusions
As the data suggests that handwritten Operation Notes were not comprehensive and legible hence replacing these with the electronic operation notes would be best practice. Fully compliant electronic operation notes, reducing in variability by opting single and procedure specific Performa will help to mitigate the issues highlighted.
424 High Volume vs. Low Volume Transversus Abdominis Plane (TAP) Blocks and Post-Operative Pain in Elective Colorectal Surgery- the More the Merrier?
Authors: McQuillian J , McCulloch L , Bruce E , Ramsay G 
Published: November 2022

Abstract

Introduction
Transversus abdominis plane (TAP) regional anaesthetic blocks are often performed by surgeons and provide effective anaglesia in the immediate postoperative period. It is not known whether the volume and concentration of local anaesthetic used for TAP blocks influences the quality of analgesia when the total drug dose is similar.

Aim
This pilot aimed to compare low volume versus high-volume TAP block and post-operative pain in patients undergoing elective colorectal surgery, using analgesic consumption as a proxy for pain.

Method
Single centre cohort study. Data were collected for patients undergoing elective colorectal resections from April – December 2021. Patients were cohorted into those receiving low-volume, high-concentration TAP block (40–50ml 0.25% levobupivacaine) and those receiving high-volume, low-concentration TAP block (100ml 0.125% levobupivacaine). Data including PCA (patient-controlled analgesia) type (morphine/ oxycodone) and post-operative consumption were collected.

Results
107 patients undergoing elective colorectal resections were identified. Data regarding TAP block usage was available for 55 patients. 23 (41.8%) patients were given high volume TAP blocks. 78.3% (p=0.56) of patients in the high-volume group were prescribed a PCA postoperatively, compared to 84.3% in the low-volume group. Median morphine PCA consumption was 11mg in the high-volume cohort, compared to 18mg in the low volume cohort (p=0.23).

Conclusions
High volume TAP block was associated with reduced requirement for a post-operative PCA and a reduced consumption of morphine PCA. Although not statistically significant in our small sample size, our results may be of interest to surgeons and suggest that the use of high-volume TAP blocks warrants further study.
995 Skin Closure in Laparoscopic Surgery – a UK Based Cross-Sectional Survey
Authors: Freer F , Shakir T , Iqbal M 
Published: November 2022

Abstract

Introduction
Effective port site closure is a major mediator of patient-reported outcome measures. Traditionally, subcuticular sutures are used to close laparoscopic trocar sites. However, this can be challenging and time-consuming to achieve an effective cosmetic outcome. Skin re-approximation using tissue adhesives, such as octylcyanoacrylate, has benefits associated with aftercare, cosmesis, time-efficiency, and wound complication rates attributed to favourable bacteriostatic properties. Despite this, there remains poor uptake of its use in clinical practice. Our aim was to gain insight into port-site closure techniques favoured by a sample of laparoscopic surgeons.

Method
A standardised questionnaire was developed and distributed electronically to surgeons in the United Kingdom. Questions were pertaining to closure material and technique. Data was collected prospectively and analysed using Prism GraphPad.

Results
63 surgeons; including 32 consultants, 22 senior trainees, 8 junior trainees and 1 allied healthcare professional participated in the study.
Regarding port sites &lt;5mm we found; 50.79% (n=32) used subcuticular sutures, 14.28% (n=9) used glue alone, and 23.80% (n=15) used glue in combination with sutures or steri-strips.
For larger port sites &gt;5mm we found 61.90% (n=39) used subcuticular sutures, 6.34% (n=4) used glue alone and 22.22% (n=14) used subcuticular sutures and glue in combination. 9.52% (n=6) used other methods of closure such as staples and sutures in combination with steri-strips.

Conclusion
Despite the many benefits of skin adhesive assisted closure, its uptake remains low in clinical practice. We suggest an approach targeting improvements in awareness and education to positively impact decision making regarding methods of trocar site closure.
568 A Very Rare Presentation of Angioleiomyoma in the Oral Cavity
Authors: Smith M , Yasen Z , Mani R 
Published: November 2022

Abstract
On the maxillofacial department, we receive many referrals of lumps or swellings in the oral cavity. The majority of these lesions are diagnosed clinically as fibroepithelial polyps or mucoceles, with excisional biopsy recommended for histopathological confirmation and removal. We report on the rare case of a 69-year-old male patient, who presented following referral from his General Dental Practitioner for a lump clinically representing a fibroepithelial polyp but was diagnosed histopathologically as an angioleiomyoma. Angioleiomyoma is a rare benign vascular smooth muscle tumour; it is very rarely seen in in the head and neck, with oral and maxillofacial lesions accounting for less than 0.5% of angioleiomyomas. We report this case to discuss clinical and histopathological diagnosis and raise awareness of it as potential differential diagnosis of lumps in the oral cavity.
507 Seizure Control in Glioma Related Epilepsy: Proposal of a Qualitative Attribute Selection for a Discrete Choice Experiment into Patient Priorities for Treatment Goals
Authors: Clynch A , Elliott M , Holmes E , Marson T , Jenkinson MD 
Published: November 2022

Abstract

Introduction
Seizures occur in ∼50% of high-grade glioma and &gt;80% of low-grade glioma patients. Recurrent seizures affect &gt;50% of low-grade gliomas. Both seizures and anti-epileptic drugs (AEDs) can impact health-related quality of life (HrQOL). Little is known about the patient preferences that feed into prescribing decisions in glioma-related seizures.

Aim
To explore key outcomes patients value in the treatment of glioma related epilepsy. To select attributes for a future Discrete Choice Experiment (DCE) that analyses the attributes traded by patients in decision making.

Method
Attribute lists will be formulated in 3 stages: (1) systematic review of glioma and epilepsy literature; (2) clinician review to highlight missing outcomes and (3) patient focus groups. There will be ∼6 focus groups on total: 4 initial concept development focus groups and 2 detailed focus groups analysing the phrasing of attributes. Patients’ recruitment starts in November 2021.

Results
Focus group transcripts will be analysed using qualitative analysis methods of thematic analysis and case deviant analysis to identify common themes and how they relate to population variables. If thematic analysis suggests a high level of heterogeneity between group sessions additional focus groups may be required. A ranked list of variables will be generated based on factors including tumour grade, primary vs recurrent tumour, seizure type and time since diagnosis.

Conclusion
There is limited research examining outcomes patients value throughout their own treatment. This study will allow clinicians to gain a much-needed insight into patient priorities during the management of glioma-related seizures.
622 Tranexamic Acid Use in Meningioma Surgery – a Systematic Review and Meta-Analysis
Authors: Gillespie CS , Clynch A , Richardson GE , Mustafa M A , Islim AI , Kumar S , Keshwara SM , Millward CP , Jenkinson MD 
Published: November 2022

Abstract

Aim
Meningioma surgery is associated with increased intraoperative bleeding and transfusion requirement. Tranexamic Acid (TXA) has been used in medical and surgical practice to reduce haemorrhage. This review aimed to evaluate the effect of TXA use on bleeding and transfusion requirement, and functional outcomes in meningioma surgery.

Method
A systematic review and meta-analysis was conducted in accordance with the PRISMA statement and registered in PROSPERO (CRD42021292157). Six databases were searched up to November 2021. Random effects meta-analysis was performed to delineate blood loss, transfusion requirements, postoperative complications, operation time, and hospital stay.

Results
Four studies (181 patients) were included (three randomised control trials, one clinical trial). TXA use significantly reduced Intraoperative blood loss (mean difference 315.69mls [95% CI -532.94 to -98.54]) and transfusion requirement (OR 0.52 [95% CI 0.27–0.98]). Factors not affected by TXA use were operation time (mean difference 0.09 hours [95% CI -0.11 to 0.29]), Post-operative seizures (OR 0.87 [95% CI 0.31–2.49]), hospital stay (mean difference -2.4 days [95% CI -3.18 to -1.62]), and disability after surgery (OR 0.47 [95% CI 0.14–1.61]). Risk of bias was low (n=3) or unclear (n=1) in all included studies. Heterogeneity was high in length of operation (I2= 90%), and hospital stay outcomes (I2= 92%), and low in all others.

Conclusions
TXA use reduces blood loss and transfusion requirement in meningioma surgery, but not post-operative complications, or disability after surgery. Larger trials are required to investigate the impact of TXA on patient-focussed post-operative outcomes.
605 Assessment of Radiological Exposure Dosage and Time Among Surgeons During On-Table Cholangiography
Authors: El Zayat I , Farrow H , Wilson I 
Published: November 2022

Abstract

Background
On-table Cholangiography (OTC) is an important diagnostic tool in biliary surgery, allowing for assessment of biliary duct patency. However, debate remains over its overall benefit and safety vs peri-operative imaging. Research into the radiation exposure to both patients and surgeons and its subsequent risks remains minimal.

Aim
The aim of this retrospective study was to assess the average radiological dosage exposure as well as total exposure time for on-table Cholangiograms performed during Laparoscopic Cholecystectomies. We also aimed to assess for any clear difference in dosage and time exposure between different levels of trainee surgeons and consultants.

Results
A total of 157 OTCs were identified over a 12-month period; 57% performed by consultants (n=91), 23% by senior trainees’ level ST6-ST8 (n=36) and 29% by trainees level ST3-ST5 (n=36). The median radiological exposure time for all cases was 27 seconds, while median dosage/area exposure was 54.84 (uGy*m2). There were no significant differences in mean and median results between the different training levels of the performing surgeon.

Conclusions
Average radiological exposure dosage/area and time was consistent throughout the different groups of surgeons. While the exposure appears to remain at relatively low levels, further research into the risk of exposure during OTCs is needed to provide guidance to surgeons performing such procedures.
704 Laparoscopic Cholecystectomy for Ultrasound Proven Gallbladder Polyps – an Unsound Indication?
Authors: Bezzaa S , Clements C , Patel P , Kumapley L , Burney K , Nehra D 
Published: November 2022

Abstract

Aim
Current European guidelines recommend cholecystectomy for ultrasound proven gallbladder polyps based on size. Over-diagnosis of gallbladder polyps by conventional transabdominal ultrasound may lead to unnecessary surgery. The aim of this study is to correlate the ultrasound findings of gallbladder ‘polyps’ with histology of the removed gallbladder specimens.

Method
Data from transabdominal ultrasound reports was collected over a 5-year period and cross-referenced with the histology from patients undergoing a laparoscopic cholecystectomy over the same time-period.

Results
60 patients who underwent laparoscopic cholecystectomy with ultrasound proven gallbladder polyps were identified. The age range was 19–79 years. There were 36 females and 24 males. On imaging 30 patients (50%) had a solitary polyp (size range 2–24mm) and 30 (50%) had multiple polyps (largest polyp size range 4–13mm). The indication for cholecystectomy was gallbladder polyps with or without gallstone disease in 32 patients (53%) and gallbladder or gallstone disease with incidental polyps in 28 patients (47%). Only 2/60 (3.3%) patients had adenomatous polyps on histology (9mm and 9.7mm on ultrasound), whilst 18/60 (30%) had pseudopolyps and in the remaining 40 specimens, no lesion of polypoidal type was found. No specimens had evidence of dysplasia or malignancy.

Conclusion
We propose that an ultrasound abdomen is an inadequate imaging modality alone to diagnose gallbladder polyps and that patients require further imaging or MDT discussion as adjuncts to decision making for those referred for consideration of cholecystectomy.
274 Retrospective Cohort Study of the Long-Term Outcome of Posterior Urethral Valve – A Single Centre Experience
Authors: Zuling ET , Mashinchi J , Radford A , Subramaniam R 
Published: November 2022

Abstract

Aim
Posterior Urethral Valves (PUV) are the most common cause of bladder outlet obstruction in male infants. Despite definitive management by endoscopic valve resection, some patients develop persistent bladder dysfunction and progressive chronic kidney disease (CKD). This study aims to evaluate the long-term complications of PUV, as well as evaluate bladder and renal dysfunction pre- and post-operatively.

Method
A retrospective review of all the patients who received PUV ablation between 2012 to 2016 in a tertiary paediatric urology centre. Data collected included demographics, laboratory and radiographic investigations, and surgical outcomes. The data were analysed with SPSS.

Results
Twenty-three patients were included in the study; antenatal diagnosis was made in 43.5% (n=10) with 56.5% (n=13) postnatally. Mean follow-up time was 7.1±2.3 years (4.8–9.4). Voiding dysfunction was the most common complication in later life (34.8%, n=8), followed by CKD (13.0%, n=3), kidney transplant (8.7%, n=2), hypertension (8.7%, n=2) and mortality (8.7%, n=2).
There was a statistically significant difference (p=0.003) between pre- and post-operative creatinine values. 5 patients who had creatinine values postoperatively of &gt;88.4μmol/L (21.7%) sustained poor renal outcomes.
Radiologically, there was a significant improvement in the anteroposterior (AP) diameter of the renal pelvis and kidney growth based on current, post-operative and preoperative ultrasound (p&lt;0.05). Nevertheless, there was no statistically significant improvement in ureteric dilatation.

Conclusions
Post PUV ablation, urinary incontinence and CKD remain the most substantial long-term outcome. Proactive multidisciplinary management with careful follow-up are essential to reduce the burden of the disease.
612 Sentinel Lymph Node Biopsy for Patients with Cutaneous Malignant Melanoma. an Audit of the First 30 Months of a New Regional Service
Authors: French B , Bond J , Tohill M , McAllister SE 
Published: November 2022

Abstract

Aim
In this region, the Sentinel Lymph Node Biopsy (SLNB) Service was established in 2018 and suspended in 2020, due to the COVID-19 pandemic. Service has resumed under interim criteria, accounting for COVID-19 constraints. Patients not fulfilling these criteria (SLNB for tumour stage pT3a or greater) had wide local excision (WLE) alone. This audit aims to examine quality of Service delivery to date, plan full-Service resumption, and generate a cohort for ongoing outcomes research.

Method
A prospectively collected database captured patients with tumour stage pT1b or higher. Data were analysed for demographics, tumour characteristics and outcome of Service referral, and compared to predetermined performance indicators.

Results
Data were collected on 410 patients, from December 2018 to April 2021; 94.4% had complete datasets. Of the remaining 5.6%, none underwent SLNB.
The mean age was 62 (range 12–96). 187 patients were male; 220 were female. The most frequent tumour location in males was the trunk (36.0%), differing from females (41.8% lower limb). The most common tumour stage was pT2a, occurring in 34.7% (27.9% males, 40.7% females).
141 eligible patients were investigated with SLNB (18.4% positive, 75.9% negative, 5.7% failed). 7.9% were unsuitable for SLNB and 4.5% declined. The remaining 168 patients did not fulfil interim criteria for SLNB and underwent WLE.

Conclusions
This audit assesses Service quality and will be used to facilitate full-Service provision. Interim criteria reflect a higher rate of positive SLNB. Ongoing research investigates the rate of false negative SLNB and impact of the COVID-19 pandemic on rates of recurrent/disseminated disease.
39 Improving Orthopaedic Morbidity and Mortality Meetings at a District General Hospital
Authors: Hunt C , Duke K , Conyers R , Plail J , Hibbard A , David L 
Published: November 2022

Abstract

Aim
M&M meetings are an integral part of Clinical Governance but can be of varying quality. They should be a learning platform and represent an opportunity to work across disciplines. We identified that these standards were not being met in our department and have sought to improve this.

Method
We compared three Orthopaedic M&M meetings against standards set out by both the Royal College of Surgeons and Physicians. Initial results suggested that documentation during the meetings did not meet these standards.
A template was created with guidance from the Royal Colleges which aimed to encourage reflection and consideration of agreed actions. This was embedded and is now part of the M&M meetings. A brief educational intervention was also undertaken during the first M&M meeting post-intervention.

Results
Data was obtained regarding the new presentation template and format. Compliance with RCS guidelines went from an aggregate 53% to 80%, following intervention. Qualitative data sought via a survey revealed agreement that the new template is superior to the old model in including relevant information, facilitating constructive discussion, and identifying learning points.

Conclusions
The new template has been well received and has helped facilitate more useful discussions around how to improve patient care. Comparison of the presentations against RCS guidelines has shown an improvement in the quality of data collected and presented. We will continue to re-audit areas such as identifying learning points to better refine and define the outcomes of M&M meetings for the benefit of patients and the multi-disciplinary team.
316 Improving Electronic Prescribing of Mechanical VTE Prophylaxis in General Surgery Patients
Authors: Gunn C , Alam I 
Published: November 2022

Abstract

Aim
Mechanical VTE prophylaxis forms part of NICE guidance in general surgical patients. Locally, thromboembolic deterrent (TED) stockings are used but not available as a prescription item on the electronic system. They are often prescribed verbally or via noted plans but do not appear on the medication administration record. Importantly, multiple incidents of patient harm through pressure damage have been seen due to poorly checked TEDs. Our aim was to audit and improve safe mechanical VTE prophylaxis prescribing.

Method
At each cycle, we retrospectively collected data from two weeks of admissions. Data relating to VTE assessment completion, VTE score, TEDs in use, TEDs prescription and LMWH prescription was collected. Our initial intervention consisted of departmental education regarding a work around enabling TEDs to be prescribed as a freehand extra-formulary item. This was reaudited at 12 months.

Results
All patients in both cycles had VTE assessments completed. TED stocking use increased significantly from 5.1% to 26.4% and prescription of TEDs, when used, increased from 0% to 61.1%. However, documentation regarding daily checks was non-existent.

Conclusions
Our QIP showed a significant improvement in TEDs use and prescription. However, the intervention is difficult and time consuming. Subsequently from this project, a TEDs stocking item is in the final approval phase for integration into the online prescribing system and will come with associated safety checks built into the nursing medication administration system. Once this is live, we will complete a third cycle to assess uptake and again at 6 months to assess for lasting change.
406 Appendicectomy: Consenting for a Normal Appendix
Authors: Probert S , Choy B , Iqbal M , Walton SJ 
Published: November 2022

Abstract

Aim
To assess consent forms for appendicectomy and ensure that patients are consented for an intraoperative finding of a normal appendix.

Method
Retrospective audit assessing consent forms (for mention of Normal appendix finding) for patients who underwent appendicectomy over a 2-month period.

Results
A total of 68 patients underwent appendicectomy. The age range of these patients was 3 to 84 years old (median 20 years). 58 of these procedures were performed laparoscopically. 23 (33.8%) of the consent forms have mention of a normal appendix. The remaining 45 patients (66.2%) had no mention of normal appendix on the consent form. In analysis of the operative notes, 7 patients had no intraoperative finding of macroscopic inflammation. Of these 7 patients, only 1 was consented for a normal appendix finding.

Conclusion
During the consent process for an appendicectomy, it is important to warn the patient (or caregiver) about the possibility of finding a normal appendix. The appendix is routinely removed regardless of the intraoperative findings (normal or inflamed). The patient should be made aware, as the appendicectomy may not result in the resolution of their symptoms, or further procedures may be required. This audit found that there is currently a deficit in consenting patients, undergoing appendicectomy, about the possibility of finding a normal appendix intraoperatively. A quality improvement project is currently underway, wherein a combination of departmental education and patient information booklets aims to improve consenting practices.