bluuebunny/crossref_metadata_2025_split huggingface dataset:
207 An Assessment of Outcome in Patients with Anaemia (Iron Deficient and Non-Iron Deficient) Who Have Colon Cancer - Effect of Treatment with Oral/ IV Iron
Authors: Sukumar A. , Khan K. , Khalid W. , Singh-Ranger D. 
Published: February 2022

Abstract

Aim
Treatment of iron deficiency anaemia in patients undergoing colon cancer resection improves outcome defined by length of stay, recurrence, and requirement for blood transfusions.

Method
Retrospective analysis of patients with anaemia and colonic cancer between January 2018 - August 2019. Anaemia categorised as – Iron Deficiency Anaemia and non- Iron Deficiency anaemia. IDA was defined as hypochromic microcytic anaemia. Patient demographics, tumour location, pre- and post-operative haemoglobin, length of stay, recurrence and requirement for blood transfusions were collected plus treatment for anaemia. Comparisons made between IDA and non-IDA groups in relation to treatment for anaemia with iron (oral/IV). Non-parametric statistical tests used (median, 2-way ANOVA, Kruskal-Wallis) with significance at P &lt;0.05.

Results
150 patients with colonic cancer identified: 77 in IDA group, 46 treated (42 oral, 4 iv iron). 11 in non- IDA group, 8 treated (oral iron).
IDA oral and IV treatment versus non-IDA:
Median age 74, 80 and 78 years (P = 0.814),
Pre- and post op Hb IDA vs non-IDA: 107, 97; 109, 101 (P 0.007 significant),
Requirement for blood transfusion (units) 0.77, 0.50;0.90 (P 0.596)
Length of Stay (days) 6, 5; 7 (P 0.113),
Tumour location: mean of right colon and transverse colon 24.33, 3.667 (P &gt;0.1), and
Recurrence P &gt;0.1.

Conclusions
In our series, iron treatment does not influence recurrence, length of stay, requirement for blood transfusions. Tumour location is not significantly different between IDA and non-IDA group. Patients treated with oral iron therapy are seen to have a larger drop in haemoglobin post operatively than the other groups.
208 Blunt Splenic Trauma, Retrospective Study 2008–2013, the Canberra Hospital
Authors: Khan Hotak M. , Fitzgerald A. 
Published: February 2022

Abstract

Aim
To evaluate the management of Blunt Splenic Trauma (BST) management in multi-injured trauma patients at The Canberra Hospital (TCH). Non operative management (NOM) for hemodynamically stable patients & operative management (OM) for unstable patients. The aim was how to further reduce failed NOM.

Method
Retrospective data collected from of all multi trauma patients with BST from June 2008 - June 2013 at TCH. Data review included patients’ admission notes, CT results, management technique, and clinical outcome.

Results
A total of 161 patients included in the study. All paediatric patients treated with NOM with success rate of 100%. Seventy-three per cent of adults managed NOM with success rate of 97.8%. Twenty-six per cent managed operatively. ICU admissions were 54.4 % and splenic angioembolisation 2.9%. Mortality was 3.7 % with multiple injury patients zero with isolated splenic injury

Conclusions
As per our study NOM is the standard of care for all hemodynamically stable patients with success rate of 97.8% acceptable rate as per evidence more than 96%. All hemodynamically unstable patients with diffuse peritonitis require urgent laparotomy. The query to answer that AE should be considered for all patients with (AAST) grade 4–5 who are hemodynamically stable as adjunct to NOM to reduce rate of fail NOM. Further randomised controlled studies are needed.
210 An Audit to Evaluate Abdominal XR Requests in Surgical Patients
Authors: Bryce A. , Al-Azzawi M. , Watt D. 
Published: February 2022

Abstract
Abdominal x-rays (AXR) are a useful tool in investigating a number of pathologies. However, they expose the patient to up to 7 times more radiation than a standard chest x-ray1. AXR’s that are requested without appropriate indication are not an efficient use of resources. Our aim was to evaluate if requests for AXR’s being made are in line with Royal College of Radiologists (RCR) iRefer guidelines2 and try improving their adherence.
Three data cycles of AXR requests made by surgical staff at Crosshouse hospital were gathered – between January & February, April, and July. Clinical history of the patients and indications in the request for the AXR were compared with guideline recommendations.
In total 52 requests for AXR’s were made during January-February, of which 32 (62%) were made appropriately and 20 (38%) did not match guidelines, as the patient’s presenting complaint and clinical history did not match one of the recommended indications to perform AXR. After circulation of educational posters, 70% of requests were made in line with guidelines in April. Followed by 77% in July after a departmental presentation on the use of AXR.
AXR’s requested during these time periods were not all made in line with guidelines. The most commonly noted error was the AXR being requested to rule out obstruction when the clinical history wasn't suspicious of obstruction. This QI project has demonstrated sustainable change and increased the adherence of AXR requests with RCR guidelines within the department.
211 A Snapshot Audit of Time to Intervention for Gallstone Pancreatitis During the First Wave of COVID-19
Authors: O'Halloran R. , Coulson R. , Magee C. 
Published: February 2022

Abstract

Aim
We evaluated time to definitive treatment of Gallstone Pancreatitis (GSP) against the BSG guidelines during the first wave of COVID-19, comparing it to data of the same time period the previous year. Did the first wave of Covid-19 impact on time to intervention for patients diagnosed with GSP?

Method
Data were obtained retrospectively for 40 patients identified via the hospital coding department that presented with GSP between March 2019 - June 2019 and March 2020 – June 2020. Patient demographics, length of stay, time to intervention and re-admission awaiting intervention were recorded.

Results
Twenty-three patients were admitted during the non-COVID period. 30% (n = 7) of the non-COVID cohort had definitive management of GSP during index admission or within 2 weeks.
Seventeen patients were admitted during the first wave of Covid-19. 64.7% (n = 11) of the COVID-19 cohort had definitive management of GSP during the index admission or within 2 weeks.

Conclusions
Prior to COVID-19, we were not meeting guidelines for definitive management on index admission / within 2 weeks. During the first wave of COVID-19, more patients received definitive management of GSP during index admission / within 2 weeks than during the non-COVID period. A higher percentage of patients received surgical management within 2 weeks than in the non-COVID cohort. Those that did not receive management within 2 weeks, waited longer for intervention and had higher rates of re-admission than the non-COVID cohort. Despite anticipated future waves of COVID-19, prioritisation of urgent OP services is essential for those diagnosed with GSP to help reduce re-admission rates whilst awaiting intervention.
212 Surgical Operation Note Audit
Authors: Ibzea S. , Kakroo B. 
Published: February 2022

Abstract

Introduction
Medical record keeping is a fundamental part of the GMC’s Good Medical Practice [1,2]. Surgeons must ensure accurate, comprehensive, and legible records are maintained [3]. An operation note is essential to ensure continuity of care between operating team and other colleagues and provides a medicolegal record of a patient’s care [4]. Handover errors have been implicated in as many as 80% of sentinel events [5], highlighting the importance of ensuring accurate record keeping.

Method
We aimed to assess compliance of surgical operation notes against the Royal College of Surgeons guidance and identified areas for improvement. 48 operation notes were reviewed at a district general hospital in the west midlands over two weeks. Operation notes on standard intranet proforma and custom operation notes were compared to determine better compliance.

Results
We identified areas of most compliance vs areas of least compliance. Most and least compliant outcomes are listed below:

Conclusions
Good compliance was noted. Using the proforma on the intranet resulted in higher compliance than custom notes (84% vs 53% respectively). Adding a complications section to standard proforma can increase compliance. This audit was performed during COVID-19 restrictions therefore investigated emergency operation notes only which limited the audit.
214 The Role of Water-Soluble Contrast Enemas in Assessing Anastomoses Prior to Ileostomy Reversal, and Their Influence on Patient Outcomes
Authors: Giucca A. , Biggs S. , Roach H. 
Published: February 2022

Abstract

Aim
Water-soluble contrast enemas (WSCE) are routinely performed to check anastomotic integrity and patency in patients who have undergone a low anterior resection and loop ileostomy formation, in preparation for subsequent ileostomy reversal. However, no specific guideline exists in this regard. Our aim was to evaluate whether WSCE influence management and patient outcomes.

Method
WSCE examinations performed between January 2019 to March 2021 were retrieved. Radiology reports, discharge summaries, and clinic letters were retrospectively collected from prospectively maintained data to determine outcomes.

Results
Over the 24-month period, we identified 63 patients who underwent a WSCE following an anterior resection. Seven had positive radiological leaks (11%), and six of these seven underwent further investigations, then either proceeded to a successful reversal (3) or are awaiting surgery (3).
Additionally, WSCE identified 10 strictures (16%). Again, due to these findings, they underwent additional investigations before proceeding to interventions (ileostomy reversal, endoscopic dilatation, or resection of stenosed anastomosis).
In total 30 patients (48%) underwent an ileostomy reversal. Only one (2%) was not successful due to a small bowel leak, not related to the low anastomosis.

Conclusions
This study demonstrates a positive WSCE result impacts subsequent investigations or interventions required. A positive result (leak or stricture) was never a contra-indication for reversal, and none of the positive results had significant postoperative complications. The only unsuccessful reversal was not related to the low anastomosis and had a normal WSCE. The exact investigations required, and their timeframe remains unclear, and we question whether radiological or endoluminal examinations should be routinely performed.
218 Compliance With the British Society for Surgery of the Hand (BSSH) Guidelines on the Management of Open Hand Fractures Audit
Authors: John H. , Nagrath N. 
Published: February 2022

Abstract

Aim
British Society of Surgery of the Hand (BSSH) have defined standards for managing open hand fractures. We intended to ascertain our and referring peripheral units’ adherence with BSSH’s standards of care in managing open hand fractures and determine the associated morbidity.

Method
We performed a 6-month prospective audit reviewing clinical records of patients referred to our department with open hand fractures, to determine whether: antibiotic prophylaxis had been started, and discontinued at definitive closure; wound washout and closure had been performed within 24 hours of injury; patients had continued rehabilitation with hand therapists.

Results
25 patients sustained open hand fractures in this period. All patients, except 1 who declined, received antibiotic prophylaxis. 19 (76%) had a wound washout and closure within 24 hours of injury.
Antibiotic prophylaxis was discontinued at time of definitive closure in theatre in 3 (12%) patients. The remaining 21 patients continued antibiotic prophylaxis beyond 72 hours. 3 (12%) patients developed a wound infection, 2 (6%) of these requiring debridement and irrigation in theatre. Both patients had proximal interphalangeal joint fracture dislocations who underwent a wound debridement within 24 hours of injury, 1 of which was secondary to an animal bite. 22 (88%) patients attended their hand therapy appointment.

Conclusions
The incidence of deep infection requiring subsequent operative debridement remains low in open hand fractures, despite the substandard adherence to BSSH’s recommendations.
Educating colleagues will improve the adherence to guidance. The BSSH hand injury triage app fulfils this purpose. We intend to raise awareness and encourage its use.
224 Measurement of the Hippocampal Volume Among a Sample of Healthy Sudanese Adults
Authors: Mohammed O.A.A. , Ibrahim A.A.H. , Salman M.S.T. , Elhassan A.B.E. , Ali M.A.M. , Bashir S.A.T. , Mustafa Ahmed W.M. , Mohamed N.E.M. 
Published: February 2022

Abstract

Aim
The hippocampus is involved in many functions; most importantly the short-term memory and memory consolidation. Hippocampal volume is an important determinant for cognition, memory function and as an indicator for the development of many diseases such as Alzheimer’s, depression, and schizophrenia. This study aimed to measure the cortical structures of the hippocampus in young adult Sudanese to examine the effect of sex, age, body mass index (BMI) and education on the cortical structures.

Method
A cross-sectional descriptive community-based study was done. It included 60 individuals within the age range of 20–40, for which, MRI imaging was done using 1.5 Tesla Philips scanners, Version: 3.2.1. T1-weighted images obtained using three-dimensional acquisition by Magnetization Prepared Rapid Acquisition (MP-RAGE). Images were analysed using the BrainSuite software, and the data was analysed using SPSS version 26.

Results
The mean volume for the right and left hippocampus was 3.22±0.92 cm3 and 3.35±0.79 cm3, respectively. The right hippocampal white matter volume and left hippocampal cortical volume were larger in males than females. There was no significant asymmetry between the right and left sides. There was no statistically significant association between the hippocampal volume and age, educational status, or the BMI.

Conclusions
Measurements of the right and left hippocampal volume among Sudanese adults goes in line with other international studies. The cortical volume of the hippocampus is not affected by age, BMI, and education level, but can be affected by gender. Further studies with larger samples are required in order to support these data.
225 First Contact: A Series of Zoom-Based, Virtual on Call Shifts
Authors: Choi B. , Fu H. , Ogunmwonyi I. , Gargan K. 
Published: February 2022

Abstract

Aim
COVID-19 has resulted in reduced exposure to on-call shifts where medical students could increase confidence and proficiency in task prioritisation and decision making. Existing ‘simulated on-calls’ provide a substitute in a controlled environment, however in person teaching has also been limited by COVID-19. Our virtual on-call sessions use ZOOM to replicate the higher-level learning experiences normally conferred by live simulation.

Method
We designed a series of virtual ‘on-calls’ for medical students. Participants were ‘on-call’, receiving ‘bleeps’ which were ‘answered’ by calling a facilitator via ZOOM. The facilitator would roleplay a scenario and the ‘Electronic Patient Record’ (EPR) on Google Forms contained patient notes and observations. Students needed to collect information from the facilitator and document a management plan into the EPR. Participants received ‘bleeps’ of varying complexity, urgency and relevance and were expected to prioritise and triage tasks accordingly. Evaluation was via a pre/post session quiz with separate feedback forms.

Results
23 students from 18 universities participated. Students reported increased confidence in managing on-call scenarios, and average scores improved in the post session quiz. Positive feedback was paid to the variety of scenarios, the EPR system and the feeling of realism elicited from the need to triage and prioritise jobs.

Conclusions
Our framework uses readily accessible technology to provide interactive learning experience. Feedback suggested students engaged in higher order learning and thinking, achieving our stated aims. We aim to incorporate technologies such as automation software which will allow for a scalable, free, and accessible virtual on call.
227 Measurement of the Cortical Structures of the Insula Among Young Adult Sudanese Using Automatic Segmentation
Authors: Salman M.S.T. , Mohammed O.A.A. , Ibrahim A.A.H. , Elhassan l.B.E. , Ali M.A.M. , Bashir S. A.T. , Ahmed W.M.M. , Mohamed N.E.M. 
Published: February 2022

Abstract

Aim
The insula is important in gustatory (taste) and visceral sensations, pain, emotion, and tactile senes. This study aimed to measure the cortical structure of the insula in young adults and the effect of gender, age, Body mass index (BMI) and education on it. This will provide base line data about cortical volume and thickness of the insula in normal subjects.

Method
A cross-sectional descriptive was done in 60 individuals, their age was ranged from 20–40 years. MRI imaging using 1.5 Tesla Philips scanners was done, version: 3.2.1. T1-weighted images was obtained using three-dimensional acquisition by Magnetization Prepared Rapid Acquisition (MP-RAGE). Images was analysed using the BrainSuite software, and the data was analysed using SPSS version 26.

Results
The mean cortical volume of the right and left insula were 8.60±1.31 and 8.01±1.26 cm3, respectively. There was significant asymmetry between the right and left sides. Additionally, there was a statistically significant difference between the cortical structures of the insula and the gender; also, there was statistically significant correlation between the insular cortical volume and the education. However, there was no statistically significant correlation between the cortical volume and age or body mass index.

Conclusions
Measurements of the right and left insula cortical structures among Sudanese adults were similar to the previous studies with males having larger volume than females. The right insula cortical volume was significantly larger than the left. I. There was a significant correlation between the cortical volume and education. Further studies with larger samples are needed to support these data.
228 Single Centre Compliance to National Guidelines for Management of Flexor Tendon Injuries, Clinical Audit
Authors: Saleki M. , Abdelaty M. , Kandil M. , Ashfaq F. 
Published: February 2022

Abstract

Aim
To evaluate compliance to British Society for Surgery of the Hand (BSSH) guidelines for timing of review and surgical management of Flexor tendon injuries.

Method
Retrospective data collection over a period of (February 2021) for the first cycle, and (June 2021) for the second cycle through EPR and Galaxy soft wares.

Results
Time from injury to review by Plastic Surgery team: 100% of patients were reviewed within the national timeframe in both cycles. Time from injury to definitive surgical procedure: 86% compliance to national timeframe on both cycles.

Conclusions
Flexor tendon injuries require further prioritization for operative management.
Increase theatre capacity to accommodate the need.
233 A Closed-Loop Audit Assessing the Compliance of General Surgery Department in Completing Treatment Escalation Plan (TEP)
Authors: Lee L. , Parmar C. , Allen C. 
Published: February 2022

Abstract

Aim
In the event of clinical deterioration, a treatment escalation plan describes individualized interventions that would be appropriate for a patient. Likewise, it allows clear communication amongst staff members and the patient about the limits of treatment. This audit aimed to evaluate the compliance of the General Surgery department during the pandemic.

Method
A closed-loop audit was conducted by looking at notes of General Surgery patients retrospectively and identifying those who’s had their treatment escalation plan form filled out during their admission. Data were collated, analysed, and presented in our local audit meeting. Thereafter, we disseminated the results to the department and modified our admission clerking proforma to ensure this is done. Afterwards, a re-audit was done to assess the improvement of compliance.

Results
A total of 24 patients were included. Before the modification of the clerking proforma, only 21% of TEP were completed. After the added changes, 36% of admitted patients had their form completed.

Conclusions
Our department was generally doing poorly with regards to ensuring our patients had TEP forms completed. Even though we generally have young, fit and well patients, according to our trust guidelines, all patients are meant to have their forms filled out. This ensures clear communication among staff and proper allocation of resources if there will be any shortages in the services that could be provided. By shining light on this topic, our department had been more compliant and proactive with ensuring that patients, especially the elderly, had a TEP form filled out.
234 Outcomes of Periprosthetic Femoral Fractures Between 2011–2021: An Observational Study
Authors: Singh H. , Bista A. , Baggott J. , Unnithan A. , Sobti A. , Farook M. , Jacob J. , Khaleel A. , Elliot D. 
Published: February 2022

Abstract

Background
Periprosthetic femoral fractures (PPFF) present a significant burden on the health services due to an increase in the ageing population and the number of hip and knee arthroplasties performed. This study observed how this burden changed between 2011 and 2021 and the outcomes for these patients undergoing an operation.

Method
Ten-year retrospective observational study assessing the variance depending on the fracture/operation, ASA scores, time to operation, length of stay and mortality.

Results
From January 2011 to March 2021, we identified 209 operations for femur periprosthetic fractures. The mean age was 83 with a female preponderance of 76%. There was a significant change in the ASA scores of the patients, with the proportion of ASA 3 or more increasing from 43% (2011–2016) to 73% (2017–2021), and ASA 4 or greater increasing from 10% to 17% respectively. There were 68 periprosthetic hip arthroplasty fracture fixations, 81 periprosthetic hip arthroplasty fracture revisions, 45 periprosthetic total knee replacements, and 15 inter-prosthetic fractures. One year mortality rates were 24.6%, 6.7%, 16.3% and 13.3% respectively. The average times to operation were 2.5 days, 4.5 days, 2.1 days, and 1.7 days respectively. The average lengths of stay were 20.8 days, 19.8 days, 12.1 days, and 13.1 days respectively.

Conclusions
PPFF carry a significant mortality risk and ASA scores have increased. Mortality rates were better in the periprosthetic hip arthroplasty patients who had revisions rather than fixations (representing different cohort). one year mortality figures were comparable to similar studies in Ireland and USA.