bluuebunny/crossref_metadata_2025_split huggingface dataset:
375 Discitis – A large cohort analysis of its management in a tertiary orthopaedics centre
Authors: Sriramanarayanan A. , Prabha S. , Prasad K. , Dholoo F. , Unnithan A. 
Published: February 2022

Abstract

Aim
Discitis is characterized as an infection of the intervertebral disc. It classically presents with fever and back pain. However, varied presentation and lack of adherence to guidelines leads to significant variation in its identification and management. We assessed adherence to guidelines, in the management of Discitis, in a tertiary orthopaedic centre.

Method
A retrospective study was conducted in a tertiary orthopaedic centre, between January 2017-September 2019. The study analysed patients with Magnetic Resonance Imaging (MRI) proven discitis.

Results
Out of the 305 spine MRIs reported as discitis, 152 (35%) had discitis based on imaging and only 38 patients (55%) clinically correlating, presenting symptoms. Back pain (47.3%) was the most common presenting complaint followed by fever. The commonest site of involvement was the lumbar vertebrae (70.4%). All patients had a baseline C-reactive protein and 34 (92.11%) had blood cultures taken. 70.5% patients with negative blood culture had Computerised Tomography (CT) -guided biopsy. Staphylococcus aureus was the most commonly isolated organism. Treatment was commonly with intravenous Flucloxacillin with 63% of the patients being treated for 6 weeks or more.

Conclusions
A structured follow up protocol will now be implemented within our centre. This will aim on correcting common errors within the management of discitis, including blood cultures prior to starting antibiotics and CT guided biopsies if blood cultures remain negative. We hope that the above will help achieve higher success rate in outcome of discitis.
378 Endovascular Stenting vs. Open Surgery in Cerebral AVF Patients
Authors: Parwez R. , Baig A. , Rahman S. 
Published: February 2022

Abstract

Introduction
Intracranial dural arteriovenous fistulae (dAVF), typically found in the dural leaflets, are vascular malformations defined by a pathological communication between meningeal arteries and dural sinus or cortical veins. Despite many of them spontaneously resolving, they are still at high risk of hemorrhage and mortality if not effectively treated and monitored. Treatment options include endovascular embolization, surgical disconnection, and radiosurgery. With the rise of endovascular treatments now widely available, there is a massive shift towards minimally invasive surgical options while it can still be argued they are not the end of open surgical repairs.

Method
We reviewed 12 cases each of endovascular embolization and microsurgical resection in our Neurosurgical Unit retrospectively and compare between length of hospital stay, hemorrhage, need for open surgery following endovascular technique and wound infection. Cases will be selected at random over a period of 6 months.

Results
We compared surgical outcomes of 12 cases each of dural AvFs that were either managed as surgical repair or endovascular embolization. In cases with associated complication, surgical repair was the preferred method although endovascular repairs had shorter length of hospital stay, lower rates of infections and rarely needed to be followed by surgical repair.

Conclusions
Based on the result we conclude that endovascular repairs have a shorter length of hospital stay, infections and hemorrhage, yet there are instances where surgical disconnection may be the preferred treatment method on a case-by-case basis. Endovascular treatment may not have replaced open surgical procedures just yet, but the future may hold more advances in this field.
379 Consenting on the Day of Surgery – Futility or Formality?
Authors: Martyn C.J. , McGowan K.E. , Clements J.M. , Kirk S. 
Published: February 2022

Abstract

Aim
Obtaining written informed consent is essential prior to proceeding with any surgical intervention. There is no consensus on the timing of when consent is complete. We aimed to assess the consent practices in our institution.

Method
A prospective snapshot audit was conducted on consecutive elective general surgical patients over a 4-week Period (August 2021). Data was collected on the content of pre-operative consent discussions as well as when the consent form was completed. Local audit approval was obtained

Results
56 patients underwent an elective general surgical procedure. Median age was 55. 73% (n = 41) were female. 63% cases were for malignant disease (n = 35). All patients completed a consent form 1. 54 patients had documented pre-operative consultations with a consultant. In all malignant cases, patients underwent discussion with a cancer specialist nurse present. All patients received a diagnosis and discussion regarding treatment. 69% of patients underwent discussion about alternative treatment options and a discussion about surgical risk took place in 30% of cases. 95% of patients signed their consent form on the day of surgery with 80% registrars and 20% consultants countersigning the forms respectively.

Conclusions
Despite the majority of patient completing their consent form on the day of surgery, the preceding consent discussions would suggest that consent is a process, and that completion of the form is a formality.
381 Is Risk of Postoperative Seizures Higher in Patients with Blood Type a in Chronic Subdural Haematoma?
Authors: Edwards B. , Zolnourian A. , Sadek A.R. 
Published: February 2022

Abstract

Introduction
Seizure is a recognised complication of Chronic Subdural Haematoma (CSDH). Blood Type A has been indicated as a risk factor for developing postoperative seizures in Acute Subdural Haematoma (ASDH). However, to our knowledge there has not been a similar study to see if there is an association between blood type and seizure risk in CSDH.

Method
699 patients who had a CSDH surgically evacuated with burr holes between 2013 and 2019 were identified and their electronic and paper notes were retrospectively reviewed. Clinical information including their blood type and occurrence of postoperative seizure were recorded.

Results
26/699 patients overall had a postoperative seizure (3.7%). Blood type A had a higher overall number of seizures (4.3%, 13/301) than other blood types (3.4%,13/379) however this difference was not statistically significant (p = 0.22).

Conclusions
There is no convincing evidence that patients with blood type A have a higher risk of seizures after CSDH than patients with other blood types. Therefore, there is no reason to manage patients with blood type A differently regarding seizure prophylaxis.
385 Improving Neurosurgical Handover: A Quality Improvement Project
Authors: Mohamed M. , Edwards B. , Parmar V. 
Published: February 2022

Abstract

Aim
Efficient, succinct, and salient handover of current issues of surgical inpatients between doctors is an essential process which, if done ineffectively can contribute to patient harm. It was recognised that existing junior neurosurgical handover could be improved and using the Royal College of Surgeons’ and NICE guidelines for clinical handover we aimed to improve the existing handover system, improving doctor’s satisfaction with handover and patient safety.

Method
19 junior doctors on the SHO rota were surveyed to establish their perspective on the existing handover process. Based on this feedback, we redesigned handover combining national bodies’ guidance and local ideas. We resurveyed following these changes to measure improvement.

Results
Initial results showed only 36 % of junior doctors were satisfied with the existing handover procedure and only 50.5% felt the existing handover was safe. After these changes there was a 44% improvement in satisfaction with handover and a 24% improvement in the perceived safety of the handover process.

Conclusions
Handovers should be optimised to improve patient care and doctors working environment. We have improved our existing handover procedure increasing the perceived safety and doctor’s satisfaction of the handover process.
388 The SIMple Things: Using Surgical Simulation to Improve Junior and Undergraduate Surgical Teaching in a Rural DGH
Authors: Bruce N. 
Published: February 2022

Abstract

Aim
Many clinical activities remain cancelled or uncertain in the COVID world. We established a Surgical Skills Club in our rural DGH, where students and juniors are rotated far from their home institution. We also aimed to improve our undergraduate teaching by incorporating new surgical Sim sessions.

Method
We established a weekly Surgical Skills Club by trainees, and promoted this through MedEd to all juniors, students and ANPs. We used a combination of higher-fidelity models owned by the hospital and low fidelity models designed by ourselves such as lap-appendix and hernia. We utilised social media to share ideas. We recorded attendance and sought written feedback. We also set up dedicated simulation sessions as part of ongoing undergraduate teaching.

Results
Anonymous feedback was documented weekly via app/online. For skills club, 100% of attendees documented experience as “great” or “good” (options great, good, average, fair, poor). Attendance varied from 2–15 each week. The best attendance was a formalised session with consultant input. For undergraduate Sim, 100% of attendees rated experience “great” or “good”. All attendees agreed Sim teaching improved their experience of surgery. 20% stated it made them consider a career in surgery.

Conclusions
Surgical simulation is an excellent tool for improving experience of general surgery especially in a COVID environment and can widen access to surgical training by allowing juniors to explore their skills in a controlled, informal environment. Lap Skills gave students real-world confidence. A combination of low fidelity models provided the best experience showing that the barrier of cost can be broken.
389 The Benefit of Pre-Emptive Peri-Incisional Local Anesthesia in Day-Case Open Hernia Repair
Authors: Ramasamy S. , Bylapudi S. K. , Toe K. 
Published: February 2022

Abstract

Introduction
Hernia repair is one of the common operations performed in the United Kingdom. The novel technique of intra-operative local anaesthesia has improved the outcomes in recovery and has reduced overnight hospital stay. The aim of the study was to compare the postoperative pain, LOS and overall satisfaction in the group where local anaesthesia (LA) was injected peri incisional versus LA at the end of the procedure.

Method
In this prospective observational study, 70 consecutive unselected men underwent open inguinal hernia repair as a day case. Of these, 35 underwent repair under GA + peri-incisional LA solution (an equal mixture of 0.5% bupivacaine and 1% lignocaine with 1:200,000 adrenaline) (Group A) and 35 with GA with LA injected at the end of the procedure (Group B). Pain score assessed postoperatively at 2 hours and the next day after the procedure telephonically. A validated patient questionnaire was used to get the satisfaction level of the patients.

Results
The median age of group A was 57.1 years, and, in group B, it was 59.7 years. All of them underwent Lichenstein hernia repair. None of them in group A had a pain score of more than three. 4 patients in group B had a pain score of more than 3 post-operatively (11%). On postoperative day 1, only one patient had pain score of 4, whereas, in Group B 14 patients (40%) had pain score &gt; 4 (P-value 0.042). Six patients (14.2%) in group B failed day-case discharge criteria. None of the patients in both groups were dissatisfied.

Conclusions
Patients undergoing day-case GA inguinal hernioplasty with peri-incisional pre-emptive LA solution infiltration have adequate postoperative pain control and a good satisfaction level. These patients are unlikely to fail discharge for planned day-case surgery.
394 Gentamicin Guidelines – Available but Are They Followed? a Retrospective Audit
Authors: Ash J. , Wolff N. 
Published: February 2022

Abstract

Introduction
Many hospitals include gentamicin as part of prescribing protocols for clinical situations such as bacterial septicemia and urinary tract infections. High doses of gentamicin can lead to nephrotoxicity and/or auditory dysfunction. To prevent this, most hospital guidelines advise to adjust dosing according to age, renal function and if the patient is overweight. With therefore quite a complex prescribing protocol, an audit of the prescribing practices at the trust was deemed necessary to determine if clinical protocol was being followed for inpatient gentamicin dosing.

Method
A retrospective audit of all patients prescribed gentamicin as an inpatient between 1st of August and 31st of October 2020 was performed. Data was collected from two separate electronic record systems and combined.

Results
2224 doses of Gentamicin (to 1224 patients) were given in the study period. Gentamicin dosing was not adjusted for obesity in either the &lt;70 or &gt;70 age group (p&lt;0.05 for both). Dosing was not adjusted for Creatine clearance (p&lt;0.05). 86% of patients that needed a gentamicin level had one taken but 15% had it taken too early. Of those who had a Gentamicin level &gt;1, 100% had their next dose held.

Conclusions
Although gentamicin levels are taken and acted on effectively in most cases, a large proportion of patients are not being dosed as per protocol and therefore at risk of the side effects of overdosing or being clinically under treated. With such a complex prescribing protocol, electronic tools need to be implemented to improve compliance across the trust.
397 Medical Reconciliation in Acute Surgical Patients – Are We Letting Our Patients Down?
Authors: Ash J. , Sanwu D. 
Published: February 2022

Abstract

Introduction
NICE guidelines state that medication reconciliation should occur within 24 hours of admission or as soon after as possible. Accurate and timely prescription of these medications is crucial to ensure optimal care. Due to the COVID-19 pandemic, primary care is busier and thus difficult to contact and with neck of kin not present, the challenges of accurate medicine reconciliation may be exacerbated.

Method
A retrospective audit was performed over a fortnight of all acute surgical admissions to a district general hospital. Data was collected as to the time regular medications were prescribed, the source of medical reconciliation and the access to GP network systems for patients.

Results
A total of 66 patients were admitted during the time period. 44 patients had regular prescriptions. Of those 68% had regular medications prescribed within 24 hours. 22% did not have regular prescriptions prescribed throughout their inpatient stay. 91% of the patients prescribed medications within 24hours had a working link to the GP network whereas only 58% of those who were never prescribed had a working system.

Conclusions
Although a good proportion of acute surgical admissions are prescribed their medications within 24 hours, the proportion who are prescribed past this point is low and a sizeable proportion are never prescribed. A significant contributing factor to this could be poor infrastructure relating to the connection between secondary and primary care and poor handover between on-call and post-take teams. Accurate drugs history during the initial clerking is crucial to mitigate these errors long term.
402 A Study to Assess Concordance Rates of Emergency Abdominal X-Ray Film Interpretation and Formal Radiological Reporting.
Authors: Masoodi S. , Van P.T.M. , Cribb E. , Pawa N. 
Published: February 2022

Abstract

Background
Abdominal X-rays (AXRs) were a key part of investigating acute abdominal pain prior to the advent of CT imaging. With increasing reliance on CT scanning, the utilisation and therefore reliance on the interpretation of AXRs has reduced. We investigate the concordance rates of interpretations of AXRs with the formal radiological report, along with the time taken for formal reporting.

Aim
To ascertain the concordance rates of interpretation of emergency AXRs with formal radiological reporting.

Method
All AXRs performed within the trust in a 15-day period were obtained retrospectively from our electronic imaging database. These were compared with the initial interpretations of the AXR, which was obtained from our electronic record system.

Results
248 AXRs were performed, 136 (55%) were not interpreted in the notes. Of the remaining 112, 88 (79%) of AXR interpretations were in concordance with radiological reporting. There was no difference in concordance rates between interpretation by the Emergency Department (ED) or ward-based doctors. The average time for AXRs to be reported was 1.5 days for ED, and 3 for inpatients.

Conclusions
One fifth of AXRs were incorrectly interpreted and more than half of AXRs were not interpreted at all. This brings into question not only their usefulness in general, but also the utilisation of resources to perform them. As all AXRs are reviewed by a consultant radiologist with little impact on decision making, does this still remain an effective utilisation of resources?
409 Audit of a Patient Satisfaction Survey for a Nasal Fracture Pathway?
Authors: Penny F. , Jones H. 
Published: February 2022

Abstract

Introduction
We present an audit of a patient satisfaction survey assessing the contentment of patients using the nasal fracture pathway created by the ENT department in University Hospital Southampton. This is a patient triggered follow-up pathway where patients presenting to the emergency department for a possible nasal fracture were given an information leaflet to self-refer if needed.

Method
The data collection took place over the phone and ranged from July to August 2021 and consisted of thirty patients. Five of which were not given the leaflet, seven were uncontactable, two did not use it and the remaining fifteen patients took part in the survey.

Results
Of the fifteen patients included 100 % were satisfied with the patient triggered pathway. The following questions were asked. Did you think the leaflet clearly explained when you should seek medical advice? 27 % said excellent, 32% very good, 32% good and 7% fair and none as poor. Did you understand when to contact ENT? 20% reported excellent, 27% very good, 32% good, 14% fair and 7% poor. Next, how easy to read was it? 27% said excellent, 32% very good, 27% good, 7% fair and 7% poor. Lastly, how well designed and formatted was it? 7% reported excellent, 60% very good, 20% good, 7% fair and none as poor.

Conclusions
This pathway was introduced due to Covid restrictions. This audit has demonstrated high user acceptability. There are resource and cost saving implications. Thus, this pathway has potential to be incorporated into routine clinical practise going forward.
410 Acute Pancreatitis Annual Review in Cumberland Infirmary
Authors: Mohamed B. , Hammouda A. , Wong A. , Canelo R. 
Published: February 2022

Abstract

Aim
To document the incidence and presentation of acute pancreatitis, and to audit the process and outcome of management of patients against the UK guidelines in Cumberland Infirmary.

Results
Out of the 206 patients who had acute pancreatitis and admitted to the Cumberland infirmary 116 were male and 90 were female.

Causes
The alcohol consumption and the biliary pathology were the commonest cause, were 56 and 96 patients, respectively. The pancreatic lesions were the cause in 6 patients. The other causes: two patients the cause of the inflammation were drugs (azathioprine and steroids), while the ERCP was the cause in 8 patient and mumps for the one patient. Out of the 9 patients of pancreatic necrosis one patient died. 10/206 Patients with diagnosis of pancreatitis have been referred to the Remote surveillance Programme for N. Pancreatitis to the Freeman Hospital. 6 patients of them have been diagnosed with pancreatic necrosis. The number of the patients died in Cumberland infirmary in 2020 with the diagnosis of acute pancreatitis are 10 patients 04.87%. (The national mortality rate is 4–10%).

Conclusions
To follow NICE Guidelines for management of acute pancreatitis: Pancreatitis, published Sep 2018. To continue a close teamwork in terms of referrals as well as HPB MDT. To report patients with pancreatic necrosis to the FRH surveillance.
412 Operative Fixation for Acetabular Fractures in the Elderly: A Prospective Cohort Study from a UK Major Trauma Centre
Authors: Petohazi A. , Musbahi O. , Akilapa O. , Gee M. , Harnett P. 
Published: February 2022

Abstract

Aim
Due to an ageing population, acetabular fractures in the elderly is on the rise. Management of this group of patients remains controversial especially as it is associated with high morbidity and mortality. With an ageing population, there will be an increasing trend in low energy associated acetabular fractures. We present the largest cohort of operatively treated acetabular geriatric patients in the UK and compare different and emerging operative techniques and technology.

Method
A review of a prospective pelvic database was conducted. All patients over the age of 60 that had an operative fixation for an acetabular fracture from 2015 to 2020 were identified. Demographic data, operative data and complications were recorded. Length of stay and in-hospital mortality were also included.

Results
109 patients were included in the study. The mean age was 73 and the mean Injury severity score was 13. The most common mechanism of injury was a fall from less than 1 meter (42%). The mean length of stay is 25 days. In-hospital mortality was 2% and 92% of patients had no in-hospital postoperative complication. A variety of metalwork was used ranging from sacroiliac screws to pelvic infix.

Conclusions
Advancements in orthopaedic implants have changed the management of geriatric acetabular fracture patients.
417 Vibrational Spectroscopy: A Rapid Tool for Soft Tissue Sarcoma Assessment
Authors: Noor Mohamed M.S. , Almond M. , Kendall C. , Dudgeon A. , Mansfield J. , Stone N. , Barr H. 
Published: February 2022

Abstract

Aim
Soft tissue sarcomas (STS) are a comparatively unusual cluster of tumours; they arise from mesenchymal tissues. Surgery remains the primary and the only potentially curative treatment for most STS subtypes.
Existing intraoperative margin assessment techniques are inadequate and the current gold standard for resection margin assessment of STS is post-operative histopathology, but this takes weeks to finalize. Consequently, an augmented surgical technique established by real-time non-destructive recognition of clear margins is essential to diminish the risk of local relapse, decrease the resection area, and enhance the effectiveness of surgical resection of STS.
Vibrational spectroscopy (VS) is a non-destructive evaluation of the atomic oscillation within a molecule. Every molecule has a unique set of vibrational modes called molecular fingerprint. We aim to use Raman spectroscopy to analyse biomolecular spectra of sarcoma and develop a potential tool for intra operative margin assessment

Method
Human sarcoma was tissue obtained from the biobank at QEHB. The samples were identified as Lipoma and Liposarcoma. The samples underwent spectral measurement with the Raman microscope and the tissue samples were then sent for histopathological analysis.

Results
The spectral evaluation clearly demonstrates the biomolecular difference between the two groups and has a potential to become an intraoperative tool.

Conclusions
A positive resection margin is the ultimate prognosticator of local relapse. There is a need for a rapid and reliable tool that can offer surgeons with instant feedback during primary procedure.