bluuebunny/crossref_metadata_2025_split huggingface dataset:
912 Do You Really Know What “Nil by Mouth” Means?
Authors: Lingam G , Oxley C 
Published: November 2022

Abstract

Aim
To assess if patients are receiving their regular pre-operative medications in according with local and national guidance and to assess if patients are being appropriately fasted pre-operatively.

Method
A prospective study performed across a 2-week period, assessing if every patient booked on the emergency theatre list was receiving the correct medications pre-operatively and if they were fasted for the appropriate length of time. This involved assessment of the patient's notes and drug chart, as well as clarification of any unknowns with the patient.

Results
65 patients met the inclusion criteria for the study; of which 28 (43%) had their regular medication prescribed. Of those, 61% did not receive their medications according to national and local guidance (medications were inappropriately held in the majority of cases). The omission of administering medication during the “nil by mouth” phase included the lack of critical medication in 3 cases: a potentially life-threatening error. Regarding fasting of the patient, it was found that the average time without drink was 14 hours 25 minutes, with the average time without food being even greater at 24 hours 12 minutes.

Conclusions
Patients are not receiving medications in the pre-operative fasting stage appropriately, this was mainly due to the incorrect assumption that “nil by mouth” is equivalent to no oral medications.
In addition to this, the study found that patients are being kept without food or drink for far too long prior to surgery and hence reducing the quality of their pre-operative status both clinically and biochemically.
944 Re Audit: Maintenance Iv Fluids Prescribing
Authors: Sehrazi SAR , Koroma P , Shetty VD 
Published: November 2022

Abstract

Aim
Many hospital admissions require intravenous (IV) fluid therapy to prevent or correct fluid status and/or electrolyte disturbances. Within our trust the recommended IV maintenance fluid is 0.18% Saline in Glucose 4%. This Re audit aimed to assess the knowledge and improve understanding of junior clinicians for IV maintenance fluid prescribing at Royal Preston Hospital by comparing our current practice to Trust guidelines/NICE guidelines

Method
A multiple choice knowledge questionnaire was used evaluate the knowledge of foundation doctors, core trainee's and advanced care practitioners (n=21). The trusts electronic system was used to review patients prescribed maintenance fluid. (n=50). 1st audit was conducted in October 2020 followed by re audit in April 2021.

Results
In 1st cycle only 16% of the patients had the recommended maintenance fluid prescribed. We displayed posters and sent email reminders of the trust IV fluid prescribing guidelines. Junior's knowledge of the IV fluid prescribing guidelines improved regarding: recommended maintenance fluid (52% to 80%), Daily fluid requirement in ml/kg/day (66% to 70%) and Recommended monitoring (52% to 100%). This ultimately led to the prescribing of 0.18% Saline in Glucose 4% in 38% of patients. Plasma-Lyte remained the most commonly fluid prescribed in both audit cycles (42% vs 50%).

Conclusion
Changes implemented after 1st cycle led to improvement is prescribing fluid of choice but there is still room for improvement. Juniors report consultant lead decisions influencing their prescribing and the availability of fluids on the wards.
978 Evaluation of the Quality of Our Consent Forms Used for Ureteroscopy and Nephroureteroscopy - Is It Time to Go Digital?
Authors: Rafi AU , Briesh M , Nadeem M 
Published: November 2022

Abstract

Aim
Consent documentation for surgical procedures must be precise and clear in order to achieve excellence in clinical practice. In this audit, we aim to compare our consent forms against BAUS information leaflets on ureteroscopy and stone procedure and assess the documentation of all serious and frequently occurring complications as mentioned on BAUS leaflet.

Method
We retrospectively reviewed the consent forms of 60 patients who underwent elective ureteroscopy between August 2020 - April 2021 to assess the quality of documentation as well as legibility of handwriting.

Results
As a total of 60 consent forms were reviewed. 35 males and 25 females contributed to the study with 59 being the median age. There were over 10 risks being commonly missed. Some of the important risks such as stone recurrence 95%, catheterisation 92%, major damage to ureter wall 86%, pain 71% and residual stone 61% were missed. The documentation also outlines other risks; ureteric stricture 53%, aesthetic risk 67%, failure to access ureter 51% and stent symptoms 47%. Minor damage to the wall of ureter 41%, alongside need of another surgery were recorded as other commonly neglected risks. However, only 7% of the consent forms did not mention bleeding and just 2% of the forms failed to include stent insertion as a common effect of procedure. Only 17% consent for did not have eligible handwriting, although this is subjective.

Conclusions
Documentation on consent forms for ureteroscopy lacks accuracy and missed important information. We propose use of digital consent form to assess compliance and quality of consent documentation.
983 Temporal Artery Biopsy - Bringing About a Much-Needed Change
Authors: Krishnakumar N , Barnes R 
Published: November 2022

Abstract

Aim
Looking into the process for sending a referral for a Temporal Artery Biopsy (TAB) and the causes of delays for the procedure at a local DGH.

Method
A retrospective review of all the TAB referrals sent and the time from referral to date of procedure over the past year done from11/2020 to 11/2021 was done. Specifically noticed points included urgency, side, time till date of procedure.

Results
Out of the 47 procedures done, 36% of the referrals were sent and about 64% were sent as urgent all of which were sent as emails to secretaries. The average time from referral to date of procedure was about 16 days, however urgent inpatient referrals with severe active symptoms were done by the 6th or 7th day from referral. About 7% of the referrals did not even include site required and 10% did not specify date since use of steroids. About 10% of the patients found to have not understood the procedure completely and its necessity which also contributed to delays.

Conclusions
This study found that a significant proportion of the TAB referrals were incomplete, that there was a need to re-review the entire patient information thus ending up in delays.
A consensus to create a new referral system specifically for TAB which includes all the relevant data for the surgeon and a new patient leaflet including a consent form which has been discussed and is in the stage of implementation for streamlining the process, improving patient experience, and causing positive impact on overall department functioning.
997 Audit Examining the Treatment of Patients Who Developed Post Operative Complications Following Appendicectomy
Authors: Garner J , Butler J , Evans T , Ferguson H 
Published: November 2022

Abstract

Aim
To identify trends in management of patients with post operative complications following appendicectomy in a district general hospital.

Method
The coding department identified patients who were admitted with appendicitis in the previous year and those who developed post operative complications. Data was gathered retrospectively from these patients using their online records.

Results
Coding identified 270 patients that were admitted between 22/10/20–29/10/21 with appendicitis. 19 patients had post operative complications. 9 had intra-abdominal collections, 5 had wound infections/collections, 3 had an ileus.
15/19 patients with complications underwent imaging, 8 had CT scans and 7 had US scans. Patients waited a mean of 0.4 days between presentation and imaging. Patients waited a mean of 2.2 and median of 0 days between imaging and appendicectomy.
12 patients had complicated appendicitis, 6 had simple appendicitis and 1 had a normal appendix. 16 patients had antibiotics pre and post operatively, 3 did not. The mean length of stay was 5.6 days for patients with complications, compared to a mean length of stay of 3.9 days for all patients with appendicitis.

Conclusions
Early identification and management of appendicitis reduces morbidity, and our centre appears to have lower than average complication rates. The patients who did develop complications, were generally imaged and operated on efficiently
An area of improvement is ensuring all patients undergoing appendicectomies are given at least one preoperative dose of antibiotics and up to 3–5 days post operatively if complicated as per WSES guidelines. We aim to re-audit this after an education drive within our department.
1007 Audit of Time to Surgery for Decompressive Craniectomy in Ischaemic Middle Cerebral Artery Stroke
Authors: Soh WY 
Published: November 2022

Abstract

Aim
Early decompressive craniectomy (DC) in patients with ischaemic middle cerebral artery (MCA) stroke is closely related to post-surgical outcomes in terms of mortality, morbidity, and functionality.
This audit compares the time to surgery for ischaemic MCA stroke patients in Hospital Sultanah Aminah Johor Bahru (HSAJB), Malaysia, with the recommended 48-hour timeframe by National Institute for Health and Care Excellence.

Method
This audit included ischaemic MCA stroke patients who underwent DC in HSAJB from 2017 to 2019. Time of symptoms onset to surgery was obtained retrospectively from Neurosurgery Department patient records. Data was analysed and compared with functional outcomes within 18 months post-surgery, where Modified Rankin Scale (mRS) of 0–3 represents favourable outcomes while mRS 4–6 shows severe disability or mortality.
Ethics approval was not required.

Results
16 out of 38 patients who met the inclusion criteria had clear documentation of time to surgery (n=16). 75% of the patients (n=12) underwent DC within 48 hours. Of these patients, only 25% (n=3) achieved mRS 0–3 post-surgery. Nevertheless, DC within 48 hours demonstrated relatively positive functional outcomes compared to DC after 48 hours, where no patients (n=0) achieved mRS 0–3.

Conclusion
Majority of ischaemic MCA stroke patients in HSAJB underwent DC within the recommended 48-hour timeframe. Despite the low probability of achieving good functional outcomes post-surgery, DC within 48 hours showed better chance of survival with less severe disability.
It is recommended to aim for DC within 48 hours in all ischaemic MCA stroke patients for better functional outcomes.
1038 Improving Adherence to Antibiotic Guidelines for the Treatment of Acute Cholecystitis: A Completed Audit Cycle
Authors: Doherty R , Stoll S , Sedighi T , Davidson C , Modi H 
Published: November 2022

Abstract

Aim
Acute cholecystitis (AC) accounts for up to one third of emergency surgical admissions. The initial management of AC includes fluid resuscitation and appropriate antibiotic therapy. The aim of this study is to audit compliance with local microbiology guidelines for the treatment of AC and to develop interventions that improve compliance rates.

Method
All patients admitted from September to December 2020 with radiologically confirmed AC were included in an initial prospective audit (n=39 patients). Antibiotic prescriptions, patient demographics, presence of fever (&gt;38°C), inflammatory markers and liver function tests were recorded. The results were disseminated, educational material produced, and antibiotic “champions” appointed to improve adherence to antibiotic guidelines. A prospective re-audit was conducted from May to June 2021 to establish the effectiveness of the interventions (n=49 patients). Compliance rates before and after the interventions were compared using a Chi-squared test. Binomial logistic regression was carried out to establish whether any patient demographic or clinical parameters were independent predictors of prescribing behaviour.

Results
Compliance to antibiotic guidelines for AC significantly improved following the interventions (12.8% vs 57.1%; p&lt;0.001). Age, gender, temperature, inflammatory markers, and liver function tests were comparable in both groups and were not found to be independent predictors of non-compliant antibiotic prescription.

Conclusions
Adherence to antibiotic guidelines for AC can be improved with educational interventions and the appointment of individuals responsible for ensuring correct prescribing behaviour. Interestingly, patient demographics, signs of sepsis or liver function did not influence prescribing behaviour, suggesting that divergence from antibiotic guidelines may be due to ingrained prescribing dogma.
1047 Regional Audit: Valid and Informed Consent for Lower Limb Arthroplasty in Orthopaedic Surgery: Are We Doing Enough?
Authors: Sohail Z , Mills R , Adebayo O , Mamarelis G , Acquaah F , Subhash S , Liew I 
Published: November 2022

Abstract

Aim
To investigate regionally the validity of the patient consent process for lower limb arthroplasty, compared to set data standards, with a view to investigating whether the consent process could be improved, and if so, how?

Method
Regional data from 8 hospital trusts (50 data sets collected from each hospital) across England was collected retrospectively from May 1st, 2021, (25 THR, 25 TKR), collated and collectively analysed against agreed, pre-determined set criterion.
Data standards included ascertaining whether alternatives to surgery were offered and exploring the likely benefits and risks.
Capacity to consent for procedure-specific surgery was measured as patients’ ability to understand, weigh up, retain, and communicate their decisions regarding surgery.
Hospitals regional data was collectively analysed.

Results
Capacity was only successfully fulfilled and documented regionally in 11.6% of hip and 13.9% of knee replacement surgeries, despite Consent Form 1 having been filled out in 94.8% and 88.5% of cases respectively, which were procedure specific in only 74.0% and 72.1% of cases.

Conclusions
Significant improvement can clearly be made to an area of already such high clinical negligence claims.
We propose a novel solution involving the digitalisation of the consent process, including multimedia surgical videos to better inform patients and reliably assist in establishing the validity of a patient's consent.
The implications of this are limited not only to Orthopaedic surgery but could have far-reaching consequences across all surgical (and indeed medical) specialties, where obtaining valid and informed consent for procedures remains integral to quality patient care.
753 Outcomes of Bariatric Surgery in Patients with Inflammatory Bowel Disease and the Development of De-Novo IBD Following Bariatric Surgery: A Systematic Review
Authors: Mian A , Khan S 
Published: November 2022

Abstract

Aim
A large proportion of patients with inflammatory bowel disease are obese. Outcomes of bariatric surgery in patients with IBD and on IBD disease course itself is not clear. Furthermore, there is some evidence that bariatric surgery can precipitate the development of De-novo IBD. Thus, the aim of this systematic review was to search the literature to summarise the evidence surrounding these questions.

Method
A comprehensive literature review was conducted based on the preferred reporting items for systematic reviews and meta-analysis guidelines (PRISMA). PUBMED, and MEDLINE databases was searched using Ovid for keywords and MeSH terms including “gastric bypass”, “sleeve gastrectomy”, “Roux-en-Y”, “Duodenal switch”, “RYGB”, “bariatric surgery” and “inflammatory bowel disease”, “IBD”, “Crohn's disease”,“Ulcerative colitis”, “UC”. Prospective and retrospective studies published up to March 2021 were included in this systematic review.

Results
22 studies met the inclusion criteria. Studies revealed that bariatric surgery is safe for patients with IBD and leads to comparable outcomes to patients without IBD. Some studies showed that patients with IBD remained in hospital for slightly longer periods of times than non IBD patients with a modest increase in the number of complications. Furthermore, studies suggest bariatric surgery may lead to the development of de-novo IBD in a selection of patients.

Conclusion
Bariatric surgery is effective for patents with IBD reporting significant weight loss at both the 6 and 12-month time points. Further studies are needed to more accurately determine if bariatric surgery can predispose to the development of De-Novo IBD in a select group of patients.
871 The Efficacy and Safety of Bariatric Surgery in Patients with End-Stage Renal Disease Awaiting Listing for Kidney Transplantation: A Systematic Review and Meta-Analysis
Authors: Varma J , Fernando S , Dengu F , Menon V , O'Callaghan J 
Published: November 2022

Abstract

Aim
Obesity is associated with adverse outcomes in end-stage renal disease (ESRD) and hinders changes for waiting list allocation of kidney transplantation (KT). Bariatric surgery (BS) is an effective solution to obesity. The authors aim to summarise the evidence for the efficacy and safety of BS in ESRD awaiting KT.

Method
We performed a systematic review and meta-analysis to determine the efficacy and safety of BS in patients with ESRD awaiting KT. A literature search of MEDLINE, EMBASE and Web of Science was conducted from inception to April 2021. The methodological quality of selected studies was assessed using the Newcastle-Ottowa tool. Our primary outcome was change in BMI, with secondary outcomes including adverse events, graft outcomes and KT listing rate.

Results
Nine observational studies met the inclusion criteria with a total of 1903 patients (43.9% male). Mean change in BMI following BS was -11.3 (-15.3 to -7.3, p &lt;0.001) within a median follow up time of 27.6 months (IQR 12 to 36.6 months). Sleeve gastrectomy (44.6%, n=849) and gastric bypass (43.6%, n=829) were the most common procedures. Mean age at BS was 47.3 years with a mean rate to KT listing of 59.9% (SD = 1.13).

Conclusion
This review highlights that BS is both safe and efficacious on patients with ESRD and can aid with optimisation for waiting list allocation.
179 A Retrospective Analysis of a Single-Centre Experience with Administration of Neoadjuvant Chemotherapy Prior to Surgical Removal of Breast Tumour
Authors: Reveendran D , Tait C , Hogan B 
Published: November 2022

Abstract

Introduction
Neoadjuvant chemotherapy (NACT) is increasingly used to aid breast preservation surgery for patients with non-conservable disease at presentation. NICE guidelines recommend offering primary systemic therapy to patients with ER- disease and/or HER2+ disease and for those with ER+ disease to reduce tumour size. This retrospective study aimed to analyse the incidence of local and systemic recurrence post NACT.

Method
A retrospective analysis of NACT usage was conducted from January 2011 to December 2020 at the Bradford Royal Infirmary. Clinical data of patients who received NACT were collected using the local Breast Unit database, Electronic Patient Record (EPR) and Systm1. Data included patient demographics, type of breast and axillary surgical procedure, histopathology of breast tumour, pathological response to NACT and time to local and/or systemic recurrence.

Results
202 patients received NACT for breast cancer between January 2011 to December 2020. Analysis showed an increasing use of NACT ranging from 2.19% of all cancers in 2013 to 14.5% in 2020. 89/202 patients underwent breast preservation surgery. 1 patient developed local recurrence at median follow up of 26 months. 42 patients developed systemic recurrence, and 40 of them had residual disease found at surgery post NACT at median follow up of 24 months.

Conclusion
Our unit has been increasingly using NACT over the last 8 years in line with guidance. Breast conserving surgery post NACT is associated with a low risk of local recurrence. The risk of systemic disease progression post NACT is very low for patients who have complete pathological response
285 Utility of Virtual New-Patient Clinics in Women Under 30
Authors: Morton J , Shaker H , Wilson R , Abbas A , Absar MS , Ntanos I , Williams K , Wright C , Nasir N 
Published: November 2022

Abstract

Aim
Virtual consultations (VC) in breast surgery have been successfully utilised during the COVID pandemic and have potential to reduce the costs of outpatient clinics as well as increase patient satisfaction. We aimed to assess the utility and safety of VC in new patient clinics in women under 30, which are considered a low-risk subgroup.

Method
Data was prospectively collected on 118 women aged under 30 who were referred from primary care to the breast clinic between December 2020 and April 2021. Clinicopathological data was collected on referrals, imaging and follow up.

Results
Median age was 24 years (range 17–30). The commonest presenting symptoms were a lump (69%), breast pain (16%) and nipple symptoms (14%). The VC was performed via video in 63 (53%) patients and via telephone alone in 55 (47%).
Nineteen patients (16%) were reassured and discharged directly from VC. Ninety-four patients (80%) underwent an outpatient ultrasound with a sonographer trained in clinical palpation. Twenty-six (27%) ultrasounds showed benign pathology with the remainder being normal. Six biopsies were performed, all of which were benign.
Seventeen (14%) patients required a face-to-face appointment with a breast surgeon after ultrasound or biopsy. Ninety-four (79%) patients were discharged after VC + ultrasound alone. No patients required surgery.

Conclusions
Utilising VC, the majority of new referrals in women under 30 did not require face-to-face appointments. VC have potential to reduce burden on new patient clinics whilst improving patient convenience. Early data suggest a low risk of compromising safety in this subgroup.
287 Retrospective Review of a Single Surgeon 5-Year Experience of Paediatric Breast Reconstruction - Challenges, Experience, and the Increasing Role of Lipofilling
Authors: Nelson A , Taghizadeh R , Hassan D 
Published: November 2022

Abstract

Aim
This case series reviews the presentation, clinical and surgical management of paediatric breast cases undertaken by a single surgeon. The series demonstrates the powerful role of lipomodelling when used with breast reshaping techniques to achieve good outcomes and avoid the need to commit young patients to breast implants.

Method
Retrospective analysis of paediatric breast referrals to a single surgeon at a regional plastic surgery breast reconstruction unit over a 5-year period.

Results
In a 5-year period, 15 cases which presented in childhood to a tertiary paediatric centre were referred on to our regional plastic surgery breast reconstruction unit. Two patients underwent correction of breast hypoplasia secondary to Poland's syndrome. Nine patients presented for breast asymmetry with associated tuberous deformity. One patient had maldevelopment of a breast secondary to a burn's contracture. Two patients presented with gigantomastia and one patient with juvenile fibroadenomas.

Conclusions
Paediatric breast abnormalities represent a small but important caseload for a breast reconstructive surgeon. This case series demonstrates the need for careful assessment and an individualised surgical plan for each patient. The surgical plan must achieve a satisfactory outcome whilst minimising the need for further procedures as the patient grows. It is the senior surgeon's preference to avoid breast implant-based reconstruction where possible. In all but one case lipomodelling combined with reshaping of the native tissue was used to good effect.